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Semelhante a Atrial Fibrillation.pptx
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Atrial Fibrillation.pptx
- 2. INTRODUCTION • A SV arrhythmia, low amplitude baseline oscillation with irregularly irregular ventricular rhythm • f-waves v/s flutter waves • Heart rate – 100 – 160 per min (if WPW then…) • Conditions when AF appears more regular- :
- 8. MECHANISMS • Multiple re-entrant waves • Rapidly discharging autonomic foci • Single re-entrant circuit with fibrillatory conduction
- 10. CAUSES OF AF • Cardiac causes - Ischemic - Non ischemic • Non cardiac - Thyrotoxicosis - Alcohol - Drugs - Obesity, OSA - Pneumonia - Trauma, Sepsis
- 11. CLINICAL FEATURES • Palpitation • Fatigue • Dyspnea • Effort intolerance • Light headedness • Polyuria • Syncope • O/E
- 13. DIAGNOSTIC EVALUATION • Onset, duration, random/particular times • TFT, RFT, Electrolytes, LFT, CXR, ECHO • ECG, Holter, etc
- 21. PATIENT MANAGEMENT : THE INTEGRATED A B C Pathway
- 22. I. ANTICOAGULATION / AVOID STROKE
- 25. LAA closure • PREVAIL and PROTECT trial • Non inferior to VKA
- 27. II. BETTER SYMPTOM CONTROL
- 28. 0
- 33. INDICATIONS FOR CATHETER ABLATION
- 37. DRUG ROUTE DOSE C/I or RECAUTIONS or COMMENTS AMIODARONE Oral 200 mg TDS X 4 wks then 200 mg OD Most effective, stop if QTc is >500 ms, ECG repeat after 4 weeks FLECAINIDE Oral 100 – 200 mg BD C/I in IHD and HFrEf, discontinue if QRS widen >25% and in pt. with LBBB, ECG after 2 wks PROPAFENONE Oral 150 – 300 mg TDS C/I in CKD, CLD. Discontinue if QRS widen >25% and in pt. with LBBB, ECG after 2 wks DRONADARONE Oral 400 mg BD Less effective than amiodarone. Not be used in NYHA class III or IV or unstable HF. Discontinue if QTc > 500 ms. ECG after 4 weeks SOTALOL Oral 80 – 160 mg BD Not be used in HFrEF, significant LVH, prolonged QT, asthma, hypokalaemia, CKD. ECG after 1 day and 2 weeks DISOPYRAMIDE Oral 100 – 400 mg BD or TDS Rarely used as it increases mortality. May be useful in vagal AF
- 39. III. CARDIOVASCULAR RISK FACTOR AND CONCOMITANT DISEASE • Lifestyle intervention - Obesity and weight loss - Alcohol and caffeine - Physical activity • Specific cardiovascular risk factor / comorbidities - Hypertension - Heart failure - Coronary artery disease - Diabetes - Sleep apnea
- 40. RECOMMENDATIONS
- 51. CKD AND AF • CKD is pro-thrombotic and AF increases CKD • In mild to moderate CKD (> 30 ml/min/m2) same recommendations • For < 30 or post transplant data lacking
- 52. PAD AND AF • OAC unless contraindicated • If with stable vascular disease the manage with OAC alone • NDDC referred over β- blocker
- 53. ENDOCRINE DISORDER AND AF • Data are limited • Stroke prevention on same principles • In hyperthyroidism - Amiodarone - RFA
- 54. GI DISORDERS AND AF • IBD increases risk of stroke and AF • Apixa / Dabigatran === Warfarin • Dabigatran should be given post meal • Same principles apply to CLD cases
- 55. HEMATLOGICAL DISORDER AND AF • Anemia is independent predictor of OAC related major bleed. • Platelet < 1 lakh requires expert opinion • Both should be investigated and corrected , if possible.
- 56. THE ELDERLY AND AF • Receive less OAC • Anti-platelets neither more effective nor safer • OAC >>>>>> Warfarin (risk : benefit profile) • Abnormal INR ↑ risk of dementia
- 59. THANK YOU
Notas do Editor
- ANTI COAGULATION BETTER SYMPTOM CONTROL CARDIOVASCULAR RISK FACTORS AND CONCOMITANT DISEASE
- GARFIELD – AF ATRIA Intermountain risk score ABC Score
- 0-2 Low Bleeding risk
- VKA are not referred due to req. of regular INR monitoring and dose adjus. BUT the are cheap. Also, the meta analysis showed OAC Asians mein more effective and safe
- In AF patients with high bleeding risk due to uncontrolled HTN, Low platelet, hemophilia, severe hepatic / renal dysfunction.
- Previously rhythm control was for – young, AF < 6 months, without structural heart disease, 1st episode. But now improve QoL and reduce AF related symptoms.
- Tell about CABANA TRIAL. Also tell about Cox Maze procedure and how difficult it is and results are not consistent in trials. aMAZE trial resuts.
- Six symptoms, including palpitations, fatigue, dizziness, dyspnoea, chest pain, and anxiety during AF, are evaluated with regard to how it affects the patient’s daily activity, ranging from none to symptom frequency or severity that leads to a discontinuation of daily activities.
- LEGACY TRIAL
- Data lacking as the patients were excluded.
- Stable vascular disease – No new vascular event in past 12 months. As beta blocker may exacerbate PAD.
- RFA should not be done when active hyperthyroid
- And this less is despite sufficient evidence available