Atrial Fibrillation quick review. Updated to december 2013.

1. Page 1

2. •Atrial reentrant
tachycardia.
Page 2

3. •No P waves.
•Presence of oscillatory waves with
low amplitude called “f” waves
with a rate of 350-600dpm.
•PR non measurable.
•RR variable.
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4. •Low ventricular response.
•HR<60dpm
•Normal ventricular response.
•HR 60-100dpm
•Fast ventricular response.
•HR>100dpm
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5. •Histopathology classification.
Primary: Without other causes.
Secondary: Related to a cardiac or systemic cause.
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6. •Chronologic.
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7. •Levy’s.
Group I. First symptomatic attack.
A: Self limiting.
B: Require treatment.
Group II. Non treated patients with recurrences.
A: Asymptomatic, recurrent identified.
B: Recurrences in more of 3 months.
C: Recurrences in less then 3 months.
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8. •Levy’s.
Group III. Patients with recurrences despite treatment.
A: Detected by ECG
B: Recurrences after 3 months.
C: Recurrences before 3 months.
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9. Multiple waves hypothesis. Random reentrant
mechanism explains RR variability.
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10. Page 10

11. A. Unique atrial contraction
focus close to pulmonary veins
generate reentrant waves.
B. Reentrant waves originated
in several ectopic focus in both
atriums.
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12. “X” indicate the origin of the impulse. Vertical lines AV conduction. Diagonal lines AV node
conduction and conduction around the reentrant circuit and perpendicular lines indicate
blockade. AJR: Accelerate Junction Rhythm.; MAT: Multifocal atrial tachycardia.; PAT:
Paroxistic Atrial Tachycardia.; RJT: Reentrant Junction tachycardia.; TACH, tachycardia.
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13. Normal
contraction
Lost of atrial
contribution
Mitral
regurgitation
Fibrillation
Less fuelling
time
Low cardiac
output
Less
coronary flux
Less cerebral
flux
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14. Page 14

15. •Arrhythmias:
•WPW.
•Reentrant SVT.
•Atrial tachycardia.
•Circular movement tachycardia.
•Sinus node disease. Who was first, the egg or the
chicken?
• Vagal
•Genetic: 10q22-q24
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19. Page 19

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21. Page 21

22. Page 22

23. Clinical
Rivaroxaban
Apixaban
ROCKET AF
Edoxaban
Betrixaban
AVERROES
ENGAGE AF
Dabigatran
EXPLORE Xa
Scenarios
CVD prevention
and systemic
Japanese-AF
ARISTOTLE
RE-LY
RELY-ABLE
embolism in AF
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24. Page 24

25. Acronym, year
Region
Europe,
Petro, 2007
North
Drugs tested
Doses of new
anticoagulant (mg)
Other antiplatelet
drugs and doses (mg)
Dabigatran vs
warfarin
50, 150, 300; all twice No aspirin, or 81 or
daily
325 mg
Dabigatran vs
warfarin
110 mg twice
Dabigatran vs
warfarin
150 mg twice
Edoxaban vs
30, 60, 120
America
Worldwide
Re-LY LD, 2009
Worldwide
Re-LY HW, 2009
Weitz, 2010
Worldwide
warfarin
daily
Daily
Concomitant use of
aspirin (at a dose of
<100 mg per day) or
other antiplatelet
agents was permitted
Concomitant use of
aspirin (at a dose of
<100 mg per day) or
other antiplatelet
agents was permitted
No restriction about
aspirin
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26. Acronym, year
ARISTOTLE J, 2011
Region
Asia
Drugs tested
Apixaban vs warfarin
Doses of new
Other antiaplatelet
anticoagulant (mg)
drugs and doses (mg)
2.5; 5; all twice daily
No restriction about
aspirin
No restriction about
aspirin lower than 165
ARISTOTLE, 2011
Worldwide
Apixaban vs warfarin
5 twice daily
mg. Aspirin and
clopidogrel together
use were exclusion
criteria
Aspirin ≤100 mg
Rocket AF, 2011
Worldwide
Rivaroxaban vs
warfarin
20
monotherapy and
thienopyridine
monotherapy allowed.
Edoxaban vs
Chung, 2011
Asia
No restriction about
30, 60
warfarin
aspirin
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27. Page 27

28. Page 28

29. Warfarin
3,42
Apixaban
2,69
High-dose dabigatran
2,28
Low-dose dabigatran
3,12
High-dose edoxaban
0,74
Low-dose edoxaban
1,91
Rivaroxaban
2,99
0
1
2
3
4
5
6
7
8
9
10
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30. Page 30

31. Warfarin
7,34
Apixaban
5,11
High-dose dabigatran
6,86
Low-dose dabigatran
5,96
High-dose edoxaban
8,61
Low-dose edoxaban
4,32
Rivaroxaban
7,48
0
1
2
3
4
5
%
6
7
8
9
10
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38. 1. Wagner, Galen S. Marriot’s Practical Electrphysiology. 11th edition
2. Sociedad Española de Cardiología. Primer curso de electrocardiografía de la SEC. 2010.
3. Arango, Ramirez y Durango. Electrocardiografía y Arritmias. Sociedad Colombiana de
Cardiología. 2010.
4. Charría y col. Texto de Cardiología. Sociedad Colombiana de Cardiología. 2007.
5. Branwald’s Heart Disease. 9na edición. Editorial ELSAVIER. 2011.
6. Heist y col. Rate control in Atrial Fibrillation: targets, methods, resynchronization considerations.
Circulation 2011, 124: 2746-2755.
7. 2011 ACCF/AHA/HRS Focused update on the magnament of patients with Atrial fibrillation
(updating 2006 guidelines): a report of the American College of Cardiology
Foundation/American Heart Association Task force on practice guidelines.
8. Camm y col. Guidelines for the magnaments of atrial fibrillation. European Heart Journal 2010.
31, 2369-2429.
9. Zipes. Cardial Electrophysiology. From cell to bedside. 5th edition. Saunders editorial.
10. Heidbuchel et al. EHRA Practical guidelines on use of NOACs in patients with non-valvular AF
(2013) Europace 15, 625-651.
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39. http://ve.linkedin.com/in/chaconlozsanfrancisco/
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