1 / 8

AF: Points of Focus

Atrial Fibrillation What is New in the 2006 ACC/AHA/ESC Guidelines HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation. May 2007. AF: Points of Focus. Classification, epidemiology, and mechanisms Consequences of AF and aims of therapy Anticoagulation Rate control

sakura
Télécharger la présentation

AF: Points of Focus

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Atrial FibrillationWhat is New in the 2006 ACC/AHA/ESC GuidelinesHRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation. May 2007

  2. AF: Points of Focus • Classification, epidemiology, and mechanisms • Consequences of AF and aims of therapy • Anticoagulation • Rate control • Rhythm control • Rate vs. rhythm control: What to do? • Catheter ablation for AF: What is the current status

  3. AF:Classification • First detected episode • Recurrent AF (after 2 or more episodes) • Paroxysmal (spontaneous termination) • Persistent (lasting beyond 7 days, or termination with drugs or DCCV) • Permanent AF: Sinus rhythm can not be restored • Lone AF: Pts. younger than 60. No clinical or echo evidence for cardiac disease • Nonvalvular AF: Cases without RMV disease, prosthetic heart valve, or valve repair.

  4. AF Definition • Paroxysmal AF: Recurrent AF (2 episodes) that terminates spontaneously within 7 days. • Persistent AF: AF which is sustained beyond seven days, or lasting less than seven days but necessitating pharmacologic or electrical cardioversion. • Longstanding persistent AF: is defined as continuous AF of greater than one-year duration. • Permanent AF: Sinus rhythm could not be restored and a decision has been made not to pursue restoration of sinus rhythm by any means, including catheter or surgical ablation.

  5. AF: Prevalence and Incidence • Prevalence: • 0.4% - 1% in the general population • 8% in population over 80 years old • Lone AF: Less than 12% of all AF cases • Incidence: • 0.1% per year in people < 40 years old • 2.0% per year in men > 80 years old • 10% is the 3-y incidence in HF patients

  6. AF: Prevalence and StrokesThe Framingham Study 30 AF prevalence Strokes attributable to AF 20 % 10 0 50–59 60–69 70–79 80–89 Age Range (years) Wolf et al. Stroke 1991;22:983-988.

  7. Cardiac causes Hypertension Coronary artery disease Congestive heart failure Pericarditis/Myocarditis Valvular heart disease Non-cardiac causes Electrolyte disturbances Thyroid dysfunction Ethanol intoxication Vagal/sympathetic imbalance Pulmonary disease Sepsis, febrile illness AF: Common Clinical Causes Appropriate work-up should be done and reversible causes identified and treated

  8. AF: Mechanisms • Rapidly firing atrial foci (hyperexcitability) • Macroreentry with fibrillatory conduction (mother wave) • Multicircuit reentry Multicircuit reentry(Mines, Garrey) Mother wave(Lewis) Hyperexcitability(Engelmann, Winterberg) Remodeling acts to make multicircuit reentry a common final pathway Nattel et al. Ann Rev Physiol 2000;62:51-77.

More Related