Page 1
•Atrial reentrant
tachycardia.

Page 2
•No P waves.
•Presence of oscillatory waves with
low amplitude called “f” waves
with a rate of 350-600dpm.
•PR non measura...
•Low ventricular response.
•HR<60dpm
•Normal ventricular response.
•HR 60-100dpm
•Fast ventricular response.
•HR>100dpm

P...
•Histopathology classification.
Primary: Without other causes.
Secondary: Related to a cardiac or systemic cause.

Page 5
•Chronologic.

Page 6
•Levy’s.
Group I. First symptomatic attack.
A: Self limiting.
B: Require treatment.
Group II. Non treated patients with re...
•Levy’s.
Group III. Patients with recurrences despite treatment.
A: Detected by ECG
B: Recurrences after 3 months.
C: Recu...
Multiple waves hypothesis. Random reentrant
mechanism explains RR variability.

Page 9
Page 10
A. Unique atrial contraction
focus close to pulmonary veins
generate reentrant waves.

B. Reentrant waves originated
in se...
“X” indicate the origin of the impulse. Vertical lines AV conduction. Diagonal lines AV node
conduction and conduction aro...
Normal
contraction
Lost of atrial
contribution
Mitral
regurgitation

Fibrillation

Less fuelling
time

Low cardiac
output
...
Page 14
•Arrhythmias:
•WPW.
•Reentrant SVT.
•Atrial tachycardia.
•Circular movement tachycardia.
•Sinus node disease. Who was firs...
Page 16
Page 17
Page 18
Page 19
Page 20
Page 21
Page 22
Clinical
Rivaroxaban

Apixaban

ROCKET AF

Edoxaban

Betrixaban

AVERROES

ENGAGE AF

Dabigatran

EXPLORE Xa

Scenarios
CV...
Page 24
Acronym, year

Region
Europe,

Petro, 2007

North

Drugs tested

Doses of new
anticoagulant (mg)

Other antiplatelet
drugs...
Acronym, year

ARISTOTLE J, 2011

Region

Asia

Drugs tested

Apixaban vs warfarin

Doses of new

Other antiaplatelet

ant...
Page 27
Page 28
Warfarin

3,42

Apixaban

2,69

High-dose dabigatran

2,28

Low-dose dabigatran

3,12

High-dose edoxaban

0,74

Low-dose ...
Page 30
Warfarin

7,34

Apixaban

5,11

High-dose dabigatran

6,86

Low-dose dabigatran

5,96

High-dose edoxaban

8,61

Low-dose ...
Page 32
Page 33
Page 34
Page 35
Page 36
Page 37
1. Wagner, Galen S. Marriot’s Practical Electrphysiology. 11th edition
2. Sociedad Española de Cardiología. Primer curso d...
http://ve.linkedin.com/in/chaconlozsanfrancisco/

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Atrial fibrillation quick review

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Atrial Fibrillation quick review.
Updated to december 2013.

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Atrial fibrillation quick review

  1. 1. Page 1
  2. 2. •Atrial reentrant tachycardia. Page 2
  3. 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. Page 3
  4. 4. •Low ventricular response. •HR<60dpm •Normal ventricular response. •HR 60-100dpm •Fast ventricular response. •HR>100dpm Page 4
  5. 5. •Histopathology classification. Primary: Without other causes. Secondary: Related to a cardiac or systemic cause. Page 5
  6. 6. •Chronologic. Page 6
  7. 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. Page 7
  8. 8. •Levy’s. Group III. Patients with recurrences despite treatment. A: Detected by ECG B: Recurrences after 3 months. C: Recurrences before 3 months. Page 8
  9. 9. Multiple waves hypothesis. Random reentrant mechanism explains RR variability. Page 9
  10. 10. Page 10
  11. 11. A. Unique atrial contraction focus close to pulmonary veins generate reentrant waves. B. Reentrant waves originated in several ectopic focus in both atriums. Page 11
  12. 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. Page 12
  13. 13. Normal contraction Lost of atrial contribution Mitral regurgitation Fibrillation Less fuelling time Low cardiac output Less coronary flux Less cerebral flux Page 13
  14. 14. Page 14
  15. 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 Page 15
  16. 16. Page 16
  17. 17. Page 17
  18. 18. Page 18
  19. 19. Page 19
  20. 20. Page 20
  21. 21. Page 21
  22. 22. Page 22
  23. 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 Page 23
  24. 24. Page 24
  25. 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 Page 25
  26. 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 Page 26
  27. 27. Page 27
  28. 28. Page 28
  29. 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 Page 29
  30. 30. Page 30
  31. 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 Page 31
  32. 32. Page 32
  33. 33. Page 33
  34. 34. Page 34
  35. 35. Page 35
  36. 36. Page 36
  37. 37. Page 37
  38. 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. Page 38
  39. 39. http://ve.linkedin.com/in/chaconlozsanfrancisco/ Page 39
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