1 / 24

Atrial Fibrillation

Atrial Fibrillation. Rate or rhythm control? Who should be anticoagulated? Other treatment strategies. Classification:. Aetiology. LONE AF. VS. ALCOHOL RHEUMATIC HYPERTENSION HYPER THYROIDISM ISCHAEMIC ETC. Classification:. Aetiology. Timing. LONE AF. FIRST EPISODE. VS. OR.

tahirah
Télécharger la présentation

Atrial Fibrillation

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 Fibrillation • Rate or rhythm control? • Who should be anticoagulated? • Other treatment strategies

  2. Classification: Aetiology LONE AF VS ALCOHOL RHEUMATIC HYPERTENSION HYPER THYROIDISM ISCHAEMIC ETC

  3. Classification: Aetiology Timing LONE AF FIRST EPISODE VS OR ALCOHOL RHEUMATIC HYPERTENSION HYPER THYROIDISM ISCHAEMIC ETC RECURRENT PAROXYSMAL PERSISTENT PERMANENT Circulation 2001;104:2118 –2150

  4. Prevalence of AF: JAMA. 2001;285:2370-2375

  5. Mechanism of AF:

  6. Mechanism of AF:

  7. Mechanism of AF:

  8. Burden of AF: Palpitations AF 5% > 65 Syncope/Presyncope Fatigue

  9. Burden of AF: Palpitations AF 5% > 65 Syncope/Presyncope Fatigue DyspnoeaOedema Stroke Heart Failure

  10. Prognosis of AF: Circulation1998;98:946-952

  11. Principles of management: • RESTORATION & MAINTENACE OF SINUS RHYTHM‘Rhythm control’ • CONTROL OF VENTRICULAR RATE‘Rate control’ • REDUCE THROMBOEMBOLIC RISK

  12. Restoration of SR: RESTORATION OF SINUS RHYTHM NB 60% REVERT SPONTANEOUSLY IN <24 HOURS ELECTRICAL 1) EXT DC SHOCK 2) INTERNAL SHOCK • PHARMACOLOGICAL • 1) FLECAINIDE: • 2) PROPAFENONE • 3) AMIODARONE • 4) DOFETILIDE

  13. Restoration of SR: ANTICOAGULATION? RESTORATION OF SINUS RHYTHM HOW LONG IN AF? NB 60% REVERT SPONTANEOUSLY IN <24 HOURS ELECTRICAL 1) EXT DC SHOCK 2) INTERNAL SHOCK • PHARMACOLOGICAL • 1) FLECAINIDE: • 2) PROPAFENONE • 3) AMIODARONE • 4) DOFETILIDE <48 HOURS NO HEPARIN 3 WEEKS WARFARIN POST SHOCK >48 HOURS 3 WEEKS WARFARIN PRE & POST SHOCK or TOE GUIDED SHOCK + 3 WEEKS WARFARIN POST SHOCK

  14. Maintenance of SR (=prevention of AF recurrences): 1) DRUG TREATMENT:

  15. Maintenance of SR (=prevention of AF recurrences): • 2) OTHER TREATMENTS: • Pacing • Atrial Defibrillators • Cardiac Surgery • Catheter radiofrequency ablation

  16. Rate control: VENTRICULAR RATE CONTROL PHARMACOLOGICAL 1) DIGOXIN 2)  BLOCKER 3) CA CHANNEL BLOCKER 4) AMIODARONE • ABLATION • RADIOFREQUENCY • ABLATION OF • ATRIOVENTRICULAR NODE • + • PACEMAKER

  17. Rate vs rhythm control: Rate (Remain in AF):Rhythm (Restore SR): advantages Good symptom control Good symptom control Simple low risk treatment Normal physiology/cardiac function Better prognosis ?? disadvantages Abnormal cardiac function Complex higher risk treatment Stroke risk ?? Antiarrhythmic drugs - proarrhythmic Worse prognosis??

  18. Rate vs rhythm control - PIAF: PIAF study Lancet 2000;356;1789-94

  19. Rate vs rhythm control – AFFIRM: n = 4000  age = 70 • Rate: • Digoxin •  Blocker • Ca channel blocker • Rhythm: • Amiodarone • Propafenone • Sotalol • +/- DC Cardioversion AFFIRM study - NASPE 2002

  20. Risk of Stroke? • 1 in 6 strokes have AF • 6 x stroke rate if have AF • TYPE OF AF IS NOT A RISK DETERMINANT Optimal INR?

  21. Who should be anticoagulated?

More Related