5th May 2025

The surgical SpR on call rings you for advice about one of their patients, an 18-year-old man with suspected appendicitis.

The surgical SpR on call rings you for advice about one of their patients, an 18-year-old man with suspected appendicitis. He is known to have congenital heart disease and has been on warfarin for many years. His ECG on admission was sinus rhythm. He is now complaining of palpitations and a repeat ECG shows AF with a HR of 130 bpm. On assessment the patient tells you he had a “Fontan operation” when younger where the vena cava is anastomosed to the pulmonary artery to bypass the pulmonary valve. He is regularly seen in a tertiary congenital heart disease clinic. His BP is 120/85 and INR is 2.3. How would you best manage this gentleman’s AF?

Select the SINGLE most appropriate option from the list below. Select ONE option only.