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Patellar tendinopathy — MRCGP AKT MCQ

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HardTendinopathyPatellar tendinopathyMRCGP AKT

A haemodynamically stable patient has symptomatic atrial fibrillation of uncertain duration. Elective cardioversion is chosen, and no TOE-guided expedited pathway is planned. What preparation is required?

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Correct answer: D — Maintain therapeutic anticoagulation for at least 3 weeks before cardioversion

The best answer is “Maintain therapeutic anticoagulation for at least 3 weeks before cardioversion”. For AF lasting more than 48 hours or of uncertain duration when rhythm control is planned, NICE advises delaying cardioversion until therapeutic anticoagulation has been maintained for at least 3 weeks, with rate control during that interval as appropriate. A transoesophageal-echocardiography-guided strategy is an alternative when minimizing pre-procedure anticoagulation is important and expertise is available. Transthoracic imaging does not exclude left-atrial-appendage thrombus, and aspirin is not an adequate substitute.

Reference: NICE NG196: Atrial fibrillation diagnosis and management: https://www.nice.org.uk/guidance/ng196/chapter/recommendations