Atrial fibrillation

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Atrial fibrillation

  1. 1. Atrial Fibrillation Steven Podnos MD
  2. 2. Pathophysiology• Most Common Arrythmia• 5% of patients over 65yoa, increases with age• Associated with hypertension, cardiomyopathy, valvular disease, ischemia, alcohol
  3. 3. Approach to Therapy• Depends on severity and comorbid conditions• Rate vs. Rhythm control• Stroke prophylaxis
  4. 4. Rythym Control• New Afib• Symptomatic Afib• Usually catheter ablation
  5. 5. Rate Control• In absence of symptoms and combined with appropriate stroke prophylaxis, equal outcome to trying rhythm control.• Pharmacologic/ Electrophysiology
  6. 6. CHADS2-stroke prophylaxis• CHF• Hypertension• Age over 75• Diabetes• Stroke
  7. 7. Initial Approach• Rate Control• Anticoagulation• Decision on Rhythm control efforts• If not know to be in afib for less than 48 hours, need 3-4 weeks (or TEE) anticoagulation before cardioversion
  8. 8. Rate Control• Calcium Channel Blockers- not the “pines”• Beta Blockers• Digoxin-only limited benefit. Adjunctive if coexistent LV dysfunction• If drugs fail, catheter ablation
  9. 9. Rhythm Control• For symptoms:• Propafenone, Flecainide for normal heart• Amiodarone/Multaq for systolic dysfunction and afib• Ablation
  10. 10. Anticoagulation• Long Term for CHADS2 score over 1-2• Coumadin vs. Pradaxa

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