Atrial fibrellation update
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Atrial fibrellation update

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Atrial fibrellation update Atrial fibrellation update Presentation Transcript

  • Atrial Fibrillation-update Fathi Maklady, MD , FRCP Professor of Cardiovascular medicine Suez Canal University
  • Atrial Fibrillation-update
    • AF is the most common sustained cardiac arrhythmia In the general population.1-2%
    • It is estimated to be doubled in the next 50Yrs as the population ages.
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  • AF-Epidemiology
    • -<0.5% age 40-50
    • -2-4% age 50-60
    • -6-8% age 60-70
    • -10-15% age>80
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  • AF- Definition
    • Rapid and uncoordinated irregular atrial activation with loss of contribution of atrial contraction to ventricular filling ,The end result is a decrease in cardiac output.
  • AF-risk
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  • AF-Risk
    • Life time risk of developing AF is 25% in those reached the age of 4oYrs.
    • Paroxysmal AF carries the same risk as persistent or permanent AF.
    • Asymptomatic or silent AF accounts for about 30% ,and may cause cryptogenic stroke.
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  • CV conditions associated with AF
    • -Age
    • -Hypertension.
    • -Heart Failure.
    • -Tachycardiomyopathy.
    • -Valvular Heart disease.
    • -Coronary artery disease.
    • -Cong Heart disease.
    • -Cardiomyopathies.
  • CV conditions associated with AF
    • Aging :due to isolation of atrial myocardium and conduction disturbance.
    • Heart failure :-AF is found in 30-40% of HF Pts.
    • Pts with HF-NHHA 11-1V is found in 30% of AF Pts.
    • Valvular HT disease are found in 30% of Pts with AF due to Lt atrial distension.
    • Cardiomyopathy is found in 10% of AF Pts.
  • CV conditions associated with AF
    • ASD is associated with AF in 10-15% of Pts.
    • Other cong HT disease :single ventricle,transposition,fontan surgery.
    • CAD is present In >20% of AF Pts.
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  • Non CV conditions associated with AF
    • Thyroid dysfunction: hyper-Hypo-subclinical.
    • Obesity: is found in25% of AF Pts.
    • Diabetes: is found in 20%.
    • COPD :in 10-15%.
    • CKD :in 10-15%
    • OSA .
  • AF-Types
    • First diagnosed AF
    • Paroxysmal: self terminated usually within 48h ,It may continue up to 7days.
    • Persistent: when AF lasts longer than 7 days or need termination by cardioversion.
    • Long standing persistent :AF lasted more than a year ,when it is decided to adopt rhythm control strategy.
    • Permanent AF:The presence of AF accepted by the patient ad physician ,and rhythm control is not pursued.
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  • Evaluation of a Pt with AF
  • Evaluation of a Pt with AF
    • History : very important
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  • Evaluation of a Pt with AF
    • Clinical Examination:
    • -BP
    • -Character of apex
    • -LVH Or HF manifestation.
    • -Valvular Ht disease.
    • -Congenital Ht disease.
    • -Other non cardiac problems eg,thyroid dysfunction, COPD,Obesity…etc
  • Evaluation of a Pt with AF
    • Routine:FBC, SC, FBS,Electrolytes,LFTs
    • TSH
    • Echocardiography: structural or functional abnormalities.
  • AF-ECG Criteria
    • Shows absolutely irregular R-R interval (arrhythmia absoluta)
    • No distinct P wave.
    • Atrial cycle length 200-300 b/m
  • Predisposing Factors for Recurrence
    • -Age.
    • -Lt Atrial size.
    • -Reduced LVF.
    • Presence of CAD.
    • Presence of valvular Ht disease. Duration of AF before cardioversion.
    • Number of recurrence.
  • AF Management
  • AF Management
    • The Goal:
    • Reduce Symptoms.
    • Prevent complications.
  • AF Management
    • Reduce symptoms :
    • -Rhythm control by antiarhythmic,electric cardioversion ,or ablation.
    • Preventing complications :
    • -Antithrombotic therapy
    • -Control of ventricular rate
    • -Adequate therapy for concomitant cardiac disease
  • AF Management
    • Rate Control vs Rhythm Control
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  • Prevention of Thromboembolic Complications
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  • Non Warfarin Therapy
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  • In-Conclusion
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  • THANK YOU