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Atrial fibrellation update

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Atrial fibrellation update

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

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