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atrial fibrillation : update

Initiation of AF. Atrial Ectopic Beat. Atrial Ectopic Beat. AF. Sinus. . . . . . . . . . . . . Pulmonary vein ectopic. AF initiation from pulmonary vein ectopic. AF maintenanceby atrial remodelling. Atrial Fibrillation. . . Fast AF

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atrial fibrillation : update

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    1. Atrial Fibrillation : Update Prapa Kanagaratnam Imperial College

    3. Atrial Fibrillation

    6. Symptoms of AF Rate related Palpitations Reduced exercise tolerance Loss of atrial contraction Lethargy Reduced exercise tolerance Thrombo-embolism Stroke

    8. Thromboembolism in AF

    19. AFFIRM thromboembolic events 70% on warfarin 62% therapeutic 3.9% ischaemic strokes >85% on warfarin 62% therapeutic 3.3% ischaemic strokes

    20. RACE thromboembolic events 99% on warfarin 7.9% (21) thrombo-embolism 6 after stopping warfarin 96% on warfarin 5.5% (14) thrombo-embolism

    23. Thromboembolic Risks and Anticoagulation(Persistent AF)

    31. Reluctance to prescribe warfarin in the elderly major deterrents to prescribing warfarin are : falls risk history of bleeding, non-compliance dementia disproportionately influenced by prior adverse experiences, quantifying the risks and benefits of therapy

    32. Anticoagulation in the elderly Patients >80 years rarely enrolled in trials and usually warfarin-tolerant subset. Consecutive patients with >1 stroke risk factor and >65 years of age 472 patients enrolled, 32% were >80 years of age cumulative incidence of major haemorrhage >80 years of age was 13.1 per 100 person-years and <80 years of age was 4.7 per 100 person-years for those (P=0.009). increased risk of haemorrhage: first 90 days of warfarin, >80 years, INR >4.0 Major haemorrhage most common among patients with CHADS scores > 3.

    38. Medical Therapy for AF

    42. AFFIRM

    44. Paroxysmal AF ablation vs drugs Drug resistant symptomatic AF PVI+CTI MI/Roof lines Up to 2 procedures in 90 day blanking period Failure >3min AF

    45. Persistent AF ablation vs drugs + CV AF lasting > 6months CPVA Up to 2 cardioversions in control group 3month blanking period 1 year event monitor

    46. AF ablation : First Line Therapy? Untreated AF for 3mths 95% Paroxysmal 50% on beta blockers CPVA only 2mth blanking period Event recorder 1 year fu

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