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Atrial Fibrillation: The Ten Messages

Atrial Fibrillation: The Ten Messages. Ali Alsayegh , MD, FRCPC,FACC Consultant Cardiologist, Consultant Cardiac Electrophysiologist. One AF is relatively common and Challenging. Prevalence of Atrial Fibrillation.

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Atrial Fibrillation: The Ten Messages

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  1. Atrial Fibrillation: The Ten Messages Ali Alsayegh, MD, FRCPC,FACC Consultant Cardiologist, Consultant Cardiac Electrophysiologist

  2. OneAF is relatively common and Challenging

  3. Prevalence of Atrial Fibrillation Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults. JAMA. 2001; 285:2370-2375

  4. Clinical Events (outcomes) affected by AF

  5. TwoTypes of AF

  6. Clinical Types

  7. Pathophysiological Types • AF cause by trigger with normal left atrium (substrate). Possible cure • AF without trigger but abnormal substrate. Progressive

  8. ThreePatient profile very well

  9. Common coexistent conditions European Heart Journal. ESC Guidelines

  10. EHRA score of AF-related symptoms AF = atrial fibrillation; EHRA = European Heart Rhythm Association

  11. CHADS2 score and stroke rate

  12. Risk factor-based point-based scoring system - CHA2DS2-VASc

  13. The HAS-BLED bleeding risk score

  14. FourTreatment Options

  15. Rate and rhythm control of AF. Mortality outcome The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators

  16. Predictor of Mortality In AFFIRM Aliot E , and Ruskin J N Eur Heart J Suppl 2008;10:H32-H54

  17. Five Prevent Stroke Before It Happens

  18. Highly preventable (65% RRR)

  19. SixNovel New Anticoagulants

  20. Approved agents for the prevention of stroke in patients with AF

  21. Antiplatelet agents used for stroke prophylaxis in patients with AF

  22. SevenRate Control is not Bad in Many Patients

  23. Optimal level of heart rate control

  24. Rate control of atrial fibrillation

  25. AV node ablation in AF patients aClass of recommendation. bLevel of evidence. AF = atrial fibrillation; AV = atrioventricular; CRT = cardiac resynchronization therapy; LV = left ventricular;LVEF = left ventricular ejection fraction; NYHA = New York Heart Association.

  26. Quality of life and symptoms after AV junctional ablation and pacing Wood M et al. Circulation 2000;101:1138-1144

  27. Choice of pacemakers afterAV node ablation

  28. EightRhythm control: Drug

  29. Principles of antiarrhythmic drugtherapy to maintain sinus rhythm • Treatment is motivated by attempts to reduce AF-relatedsymptoms. • Efficacy of antiarrhythmic drugs to maintain sinus rhythm is modest. • Clinically successful antiarrhythmic drug therapy may reduce ratherthan eliminate recurrence of AF. • If one antiarrhythmic drug ‘fails’ a clinically acceptable responsemay be achieved with another agent. • Drug-induced proarrhythmia or extra-cardiac side-effects arefrequent. • Safety rather than efficacy considerations should primarily guidethe choice of antiarrhythmic agent.

  30. Chance of Staying in Sinus Rhythm

  31. Choice of antiarrhythmic drugaccording to underlying pathology

  32. Nine Rhythm control: Left Atial Ablation

  33. Current approaches to catheter ablation • Catheter ablation is currently based on four main strategies: • Isolation of the triggers and perpetuating re-entrant circuits located in the pulmonary veins; • Disruption of the substrate for perpetuating rotors in the antra of the pulmonary veins; • Disruption of putative dominant rotors in the left and right atria, recognized by high-frequency complex fractionated electrograms during mapping of AF. • Targeted ablation of ganglionated autonomic plexi in the epicardial fat pads.

  34. Pulmonary veins isolation

  35. Success Rate of AF Ablation

  36. Rhythm control more likely to succeed • Recent Onset AF • No structural heart disease • Small LA • Younger Age • Reversed precipitating factor

  37. TenNewer Therapeutic options

  38. Blood thinner alternative: Left Atrial Occlusion Device

  39. Investigational AntiarrhythmicAgents

  40. Summary for AF Management from ESC Guidelines

  41. Thank You

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