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Atrial fibrillation may develop in elderly patients with hyperthyroidism indicating long standing thyroid disease and underlying ischaemic heart disease.
Digoxin alone has little value and should be combined with propanolol. Additional anticoagulant therapy reduces the risk of emboli and is continued until sinus rhythm is established or it is clear that the atrial fibrillation won't resolve.
Following treatment, about 50% of patients spontaneously revert to sinus rhythm. In a further 20%, cardioversion achieves sinus rhythm.
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