For each patient with AF, the two principal goals of therapy are symptom control and the prevention of thromboembolism.
Rate- and rhythm-control strategies improve symptoms, but neither has been conclusively shown to improve survival compared to the other.
Rate vs rhythm control, what is new in esc 2020salah_atta
The document discusses rate and rhythm control strategies for atrial fibrillation (AF) management. It recommends that a target heart rate of under 80 beats per minute at rest and under 110 beats per minute is sufficient for rate control of AF. While some antiarrhythmic drugs can help with rate control, amiodarone should generally only be used for rhythm control. Catheter ablation and pacemakers are options for non-pharmacological rate control. The document also discusses catheter ablation as a first-line therapy for AF according to recent clinical trials, and lifestyle modifications that can help reduce AF recurrence after ablation.
This document discusses localization of accessory pathways using electrocardiography. It describes that accessory pathways can be located in eight anatomical positions along the tricuspid and mitral valve annuli. Several algorithms are proposed to determine the location based on delta wave polarity and amplitude in various leads. The most accurate is the Arruda approach, which uses step-wise analysis of delta wave characteristics in leads I, II, aVL, aVF and V1 to identify the specific accessory pathway location with 90% sensitivity and 99% specificity. Characteristic ECG patterns are presented that help localize right anteroseptal, right posteroseptal, left lateral and right free wall accessory pathways.
Cardiac arrhythmias occur frequently in ICU patients, with the most common being sinus tachycardia. Arrhythmias are often seen in patients with structural heart disease and can be exacerbated by critical illness. Management involves treating any imbalances that may be triggering the arrhythmia as well as directed medical therapy. Arrhythmias in the ICU represent a major source of morbidity and increased length of stay.
This document discusses troubleshooting of implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT). It describes evaluating patients who receive shocks from their ICD and assessing ineffective or absent treatment. The document outlines different causes of oversensing that can lead to inappropriate shocks, such as P-wave oversensing, R-wave double counting, and T-wave oversensing. It provides guidance on approaches to reduce oversensing, including adjusting sensitivity thresholds and blanking periods. The document emphasizes that identifying and addressing lead failures is important for preventing repetitive inappropriate shocks.
1) The document defines wide complex tachycardia as a rhythm with a QRS duration ≥120ms and heart rate >100 bpm.
2) The main causes listed are ventricular tachycardia (80% of cases) and supraventricular tachycardia with aberrancy.
3) Key features that can help differentiate the underlying rhythm include QRS duration, axis, morphology, and the presence or absence of AV dissociation on electrocardiogram.
Today, in addition to measurement of left ventricular ejection fraction, the simple 12-lead surface ECG remains the only evidence-based means of identifying patients who may obtain the substantial benefits of CRT
This document provides an overview of arrhythmias that may present in the intensive care unit (ICU) with a focus on atrial fibrillation, wide complex tachycardia, bradycardia, and supraventricular tachycardia. It discusses approaches to determining whether arrhythmias require rate or rhythm control and outlines treatment strategies including pharmacological and electrical cardioversion. Guidelines for determining the need for anticoagulation based on a patient's CHADS2-VASc score are also reviewed.
The document discusses intracardiac electrograms (IEGMs) and catheter positions used in electrophysiology studies. It provides information on unipolar and bipolar recordings, including how bipolar signals are constructed and how they approximate the rate of change of the cardiac wavefront. The document also discusses how the direction of cardiac activation influences the electrocardiogram and how unipolar and bipolar recordings compare. Key factors that influence electrogram morphology such as conduction speed, myocardial mass, and tissue characteristics are also reviewed.
Rate vs rhythm control, what is new in esc 2020salah_atta
The document discusses rate and rhythm control strategies for atrial fibrillation (AF) management. It recommends that a target heart rate of under 80 beats per minute at rest and under 110 beats per minute is sufficient for rate control of AF. While some antiarrhythmic drugs can help with rate control, amiodarone should generally only be used for rhythm control. Catheter ablation and pacemakers are options for non-pharmacological rate control. The document also discusses catheter ablation as a first-line therapy for AF according to recent clinical trials, and lifestyle modifications that can help reduce AF recurrence after ablation.
This document discusses localization of accessory pathways using electrocardiography. It describes that accessory pathways can be located in eight anatomical positions along the tricuspid and mitral valve annuli. Several algorithms are proposed to determine the location based on delta wave polarity and amplitude in various leads. The most accurate is the Arruda approach, which uses step-wise analysis of delta wave characteristics in leads I, II, aVL, aVF and V1 to identify the specific accessory pathway location with 90% sensitivity and 99% specificity. Characteristic ECG patterns are presented that help localize right anteroseptal, right posteroseptal, left lateral and right free wall accessory pathways.
Cardiac arrhythmias occur frequently in ICU patients, with the most common being sinus tachycardia. Arrhythmias are often seen in patients with structural heart disease and can be exacerbated by critical illness. Management involves treating any imbalances that may be triggering the arrhythmia as well as directed medical therapy. Arrhythmias in the ICU represent a major source of morbidity and increased length of stay.
This document discusses troubleshooting of implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT). It describes evaluating patients who receive shocks from their ICD and assessing ineffective or absent treatment. The document outlines different causes of oversensing that can lead to inappropriate shocks, such as P-wave oversensing, R-wave double counting, and T-wave oversensing. It provides guidance on approaches to reduce oversensing, including adjusting sensitivity thresholds and blanking periods. The document emphasizes that identifying and addressing lead failures is important for preventing repetitive inappropriate shocks.
1) The document defines wide complex tachycardia as a rhythm with a QRS duration ≥120ms and heart rate >100 bpm.
2) The main causes listed are ventricular tachycardia (80% of cases) and supraventricular tachycardia with aberrancy.
3) Key features that can help differentiate the underlying rhythm include QRS duration, axis, morphology, and the presence or absence of AV dissociation on electrocardiogram.
Today, in addition to measurement of left ventricular ejection fraction, the simple 12-lead surface ECG remains the only evidence-based means of identifying patients who may obtain the substantial benefits of CRT
This document provides an overview of arrhythmias that may present in the intensive care unit (ICU) with a focus on atrial fibrillation, wide complex tachycardia, bradycardia, and supraventricular tachycardia. It discusses approaches to determining whether arrhythmias require rate or rhythm control and outlines treatment strategies including pharmacological and electrical cardioversion. Guidelines for determining the need for anticoagulation based on a patient's CHADS2-VASc score are also reviewed.
The document discusses intracardiac electrograms (IEGMs) and catheter positions used in electrophysiology studies. It provides information on unipolar and bipolar recordings, including how bipolar signals are constructed and how they approximate the rate of change of the cardiac wavefront. The document also discusses how the direction of cardiac activation influences the electrocardiogram and how unipolar and bipolar recordings compare. Key factors that influence electrogram morphology such as conduction speed, myocardial mass, and tissue characteristics are also reviewed.
1. Atrial fibrillation (AF) is a common arrhythmia where abnormal electrical signals in the atria cause an irregular heartbeat.
2. AF increases the risk of stroke by 5 times and is associated with increased mortality, hospitalization, and decreased quality of life.
3. Management involves rate or rhythm control as well as anticoagulation to prevent stroke, with treatment depending on factors like symptoms, age, and stroke risk level.
The document provides information about various cardiac conditions that can be identified on ECGs, echocardiograms, chest x-rays and other cardiac tests. It describes the findings and diagnoses for 12 different clinical cases, including polymorphic atrial tachycardia, preexcited atrial fibrillation, AV nodal reentrant tachycardia, Brugada syndrome, R-on-T phenomenon, hypokalemia, catecholaminergic polymorphic ventricular tachycardia, atrial lead dislodgment, atrial flutter, pulmonary and aortic pressures in ventricular septal defect, and intra-aortic balloon pump positioning.
Right ventricular infarction (RVI) is rare but can occur alongside inferior wall myocardial infarction. It carries a higher mortality risk than inferior MI alone. RVI results from occlusion of the right coronary artery, with clinical features including hypotension, clear lung fields, and elevated jugular venous pressure. Diagnosis involves ECG showing ST elevations in right-sided leads and echocardiogram demonstrating right ventricular dysfunction. Treatment aims to support right ventricular preload and restore atrioventricular synchrony using inotropic support when needed. Combined therapies including inhaled nitric oxide and IABP may benefit patients with cardiogenic shock.
The document discusses various clinical trials related to cardiovascular diseases. It summarizes the ACCORD BP study which found that targeting a SBP of <120 mm Hg compared to <140 mm Hg in patients with type 2 diabetes did not reduce cardiovascular events. It also summarizes the HOPE trial which found that ramipril reduced cardiovascular deaths, myocardial infarction, and stroke in high-risk patients without low ejection fraction or heart failure. Finally, it summarizes the EUROPA trial which found that perindopril reduced the primary endpoint of cardiovascular mortality, non-fatal MI, and cardiac arrest in patients with stable coronary artery disease.
2022 Guideline for the Management of Heart Failure Clinical Update.pptxsubhankar16
This document summarizes guidelines from the 2022 AHA/ACC/HFSA for the diagnosis and management of heart failure. It defines the stages of heart failure from A to D and discusses evaluation, causes, biomarkers, imaging, and invasive testing. Key recommendations include using biomarkers like BNP and NT-proBNP to diagnose and manage HF. Transthoracic echocardiography is recommended for initial evaluation, and cardiac MRI, CT, or nuclear imaging if echo is inadequate. Invasive procedures are not routinely recommended but may help in select cases. Remote monitoring can benefit some patients with advanced HF.
Cardiac catheterization is useful for assessing left-to-right shunts through three main techniques: oximetry runs to detect oxygen saturation step-ups, indicator dye dilution to detect early recirculation of dye injected into the proximal chamber, and angiocardiography to directly visualize the anatomic site of the shunt. While oximetry is best to localize the shunt, dye dilution can detect smaller shunts and angiography confirms anatomy. Together these techniques allow diagnosis and quantification of left-to-right intracardiac shunts.
This document discusses techniques for localizing the site of origin of ventricular tachycardia based on electrocardiogram characteristics. It describes that right ventricular outflow tract tachycardias typically present with left bundle branch block morphology while left ventricular sites may present with either right or left bundle branch block depending on exit site. Specific leads are discussed that can provide clues about anterior vs posterior, septal vs free wall origin within the outflow tracts. Other areas like fascicles, papillary muscles and mitral/tricuspid annuli are also summarized.
The document discusses guidelines for assessing diastolic dysfunction according to the ASE/EACVI 2016 guidelines. It defines diastolic dysfunction and describes the stages from grade I to grade IV. For each grade, it discusses the pathophysiology and key echocardiographic findings including mitral inflow patterns, tissue Doppler measurements, pulmonary vein flow, and left atrial size. The guidelines simplify the assessment of diastolic function into four grades based on parameters of left ventricular relaxation, left atrial pressure, mitral E/A ratio, E/e' ratio, pulmonary vein flow, and left atrial size.
This document discusses vascular access during cardiac catheterization. It covers various access sites including femoral, radial, brachial and ulnar arteries as well as internal jugular, subclavian and femoral veins. Potential complications of vascular access like hematoma, pseudoaneurysm, retroperitoneal hemorrhage and arteriovenous fistula are described. Risk factors, diagnosis and management of these complications are provided. Prevention strategies to avoid vascular access complications are also mentioned.
This document discusses various types of tachyarrhythmias categorized by their anatomical location and electrophysiological mechanisms. It describes atrial arrhythmias including sinus tachycardia, atrial fibrillation, atrial flutter, and atrial tachycardia. It also discusses atrioventricular node reentrant tachycardia, atrioventricular reentrant tachycardia, junctional tachycardia, and ventricular arrhythmias including monomorphic ventricular tachycardia, polymorphic ventricular tachycardia, and ventricular fibrillation. Key features and mechanisms of each type are outlined to aid in diagnosis and classification.
This document presents information on various types of atrial arrhythmias. It discusses premature atrial complexes, atrial tachycardia, multifocal atrial tachycardia, atrial flutter, atrial fibrillation, and wandering atrial pacemaker. For each type, it covers etiology, characteristics, and treatment approaches. The document is presented by Baby Haokip from the College of Nursing, NEIGRIHMS.
This document provides an overview of AV nodal reentrant tachycardia (AVNRT) including its mechanisms, diagnosis using electrophysiology study techniques, and treatment with catheter ablation. It discusses the criteria for diagnosing dual AV nodal physiology, how AVNRT is initiated via programmed stimulation, its characteristic surface ECG patterns, and how the arrhythmia responds to different tests such as atrial and ventricular stimulation. The document emphasizes that AVNRT is the most common type of supraventricular tachycardia and is due to reentry involving slow and fast pathways in the AV node.
This document discusses electrophysiology (EP) studies and catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT). It describes the indications, equipment, and basic procedures for EP studies including catheter placement and recording intracardiac electrograms. It explains typical and atypical forms of AVNRT and how they are characterized during EP studies. It also outlines the mechanisms, techniques, success rates, and complications of slow pathway ablation for treating AVNRT.
This document defines and discusses the management of supraventricular tachyarrhythmias. It begins by defining terms like tachyarrhythmia, tachycardia, and supraventricular tachyarrhythmia. It then discusses various types of supraventricular tachycardias that arise from different areas of the heart including the sinoatrial node, atrioventricular node, atria, and accessory pathways. The document provides guidance on clinical evaluation, ECG patterns, mechanisms, and treatment approaches for common supraventricular tachycardias such as AV nodal reentrant tachycardia, AV reentrant tachycardia, atrial fibrillation, atrial flutter, and atrial
This document discusses the history and evidence for cardiac resynchronization therapy (CRT). It notes that approximately 25% of heart failure patients have intraventricular conduction delays that cause dyssynchronous contraction. CRT aims to resynchronize contraction by pacing both ventricles simultaneously. Randomized controlled trials found CRT improves symptoms, exercise capacity, and survival in patients with low ejection fraction and wide QRS. Guidelines recommend CRT for class III/IV heart failure patients with LBBB morphology and QRS >120ms. Some evidence also supports benefit in milder heart failure. Response can vary and not all patients respond equally.
Assessment of prosthetic valve functionSwapnil Garde
This document discusses the assessment of prosthetic valve function through various imaging modalities. It begins with an introduction to prosthetic valves and outlines topics to be covered, including classification of valve types. Evaluation methods like chest x-ray, fluoroscopy, echocardiography, and CT are described. Parameters assessed on each modality and guidelines for evaluation are provided. Complications of prosthetic valves and 3D imaging advances are also mentioned.
Diastolic heart failure occurs when the ventricles become stiff and cannot relax fully during diastole. This prevents full ventricular filling and blood backs up in the organs. Around half of heart failure patients have diastolic heart failure. Diagnosis relies on echocardiogram showing diastolic dysfunction. Treatment focuses on controlling hypertension, volume overload, and other causes through medications like ACE inhibitors, diuretics and beta blockers.
1. Rate control has equivalent efficacy to rhythm control for managing atrial fibrillation and has less drug-related side effects.
2. Drugs like digoxin, beta blockers, and calcium channel blockers can be used for rate control, while antiarrhythmics like amiodarone, dofetilide and sotalol are used for rhythm control.
3. Electrical cardioversion can be used to restore sinus rhythm but has a risk of recurrence, so anticoagulation is recommended afterwards to prevent stroke from clots that may form during the arrhythmia.
1) The EAST-AFNET trial compared an early rhythm control strategy to usual care for patients with recent-onset atrial fibrillation.
2) The early rhythm control strategy involved early use of antiarrhythmic drugs or ablation to maintain sinus rhythm, while usual care followed guidelines.
3) The trial was stopped early as early rhythm control reduced the composite outcome of death, stroke, or hospitalization compared to usual care over 5 years of follow-up.
1. Atrial fibrillation (AF) is a common arrhythmia where abnormal electrical signals in the atria cause an irregular heartbeat.
2. AF increases the risk of stroke by 5 times and is associated with increased mortality, hospitalization, and decreased quality of life.
3. Management involves rate or rhythm control as well as anticoagulation to prevent stroke, with treatment depending on factors like symptoms, age, and stroke risk level.
The document provides information about various cardiac conditions that can be identified on ECGs, echocardiograms, chest x-rays and other cardiac tests. It describes the findings and diagnoses for 12 different clinical cases, including polymorphic atrial tachycardia, preexcited atrial fibrillation, AV nodal reentrant tachycardia, Brugada syndrome, R-on-T phenomenon, hypokalemia, catecholaminergic polymorphic ventricular tachycardia, atrial lead dislodgment, atrial flutter, pulmonary and aortic pressures in ventricular septal defect, and intra-aortic balloon pump positioning.
Right ventricular infarction (RVI) is rare but can occur alongside inferior wall myocardial infarction. It carries a higher mortality risk than inferior MI alone. RVI results from occlusion of the right coronary artery, with clinical features including hypotension, clear lung fields, and elevated jugular venous pressure. Diagnosis involves ECG showing ST elevations in right-sided leads and echocardiogram demonstrating right ventricular dysfunction. Treatment aims to support right ventricular preload and restore atrioventricular synchrony using inotropic support when needed. Combined therapies including inhaled nitric oxide and IABP may benefit patients with cardiogenic shock.
The document discusses various clinical trials related to cardiovascular diseases. It summarizes the ACCORD BP study which found that targeting a SBP of <120 mm Hg compared to <140 mm Hg in patients with type 2 diabetes did not reduce cardiovascular events. It also summarizes the HOPE trial which found that ramipril reduced cardiovascular deaths, myocardial infarction, and stroke in high-risk patients without low ejection fraction or heart failure. Finally, it summarizes the EUROPA trial which found that perindopril reduced the primary endpoint of cardiovascular mortality, non-fatal MI, and cardiac arrest in patients with stable coronary artery disease.
2022 Guideline for the Management of Heart Failure Clinical Update.pptxsubhankar16
This document summarizes guidelines from the 2022 AHA/ACC/HFSA for the diagnosis and management of heart failure. It defines the stages of heart failure from A to D and discusses evaluation, causes, biomarkers, imaging, and invasive testing. Key recommendations include using biomarkers like BNP and NT-proBNP to diagnose and manage HF. Transthoracic echocardiography is recommended for initial evaluation, and cardiac MRI, CT, or nuclear imaging if echo is inadequate. Invasive procedures are not routinely recommended but may help in select cases. Remote monitoring can benefit some patients with advanced HF.
Cardiac catheterization is useful for assessing left-to-right shunts through three main techniques: oximetry runs to detect oxygen saturation step-ups, indicator dye dilution to detect early recirculation of dye injected into the proximal chamber, and angiocardiography to directly visualize the anatomic site of the shunt. While oximetry is best to localize the shunt, dye dilution can detect smaller shunts and angiography confirms anatomy. Together these techniques allow diagnosis and quantification of left-to-right intracardiac shunts.
This document discusses techniques for localizing the site of origin of ventricular tachycardia based on electrocardiogram characteristics. It describes that right ventricular outflow tract tachycardias typically present with left bundle branch block morphology while left ventricular sites may present with either right or left bundle branch block depending on exit site. Specific leads are discussed that can provide clues about anterior vs posterior, septal vs free wall origin within the outflow tracts. Other areas like fascicles, papillary muscles and mitral/tricuspid annuli are also summarized.
The document discusses guidelines for assessing diastolic dysfunction according to the ASE/EACVI 2016 guidelines. It defines diastolic dysfunction and describes the stages from grade I to grade IV. For each grade, it discusses the pathophysiology and key echocardiographic findings including mitral inflow patterns, tissue Doppler measurements, pulmonary vein flow, and left atrial size. The guidelines simplify the assessment of diastolic function into four grades based on parameters of left ventricular relaxation, left atrial pressure, mitral E/A ratio, E/e' ratio, pulmonary vein flow, and left atrial size.
This document discusses vascular access during cardiac catheterization. It covers various access sites including femoral, radial, brachial and ulnar arteries as well as internal jugular, subclavian and femoral veins. Potential complications of vascular access like hematoma, pseudoaneurysm, retroperitoneal hemorrhage and arteriovenous fistula are described. Risk factors, diagnosis and management of these complications are provided. Prevention strategies to avoid vascular access complications are also mentioned.
This document discusses various types of tachyarrhythmias categorized by their anatomical location and electrophysiological mechanisms. It describes atrial arrhythmias including sinus tachycardia, atrial fibrillation, atrial flutter, and atrial tachycardia. It also discusses atrioventricular node reentrant tachycardia, atrioventricular reentrant tachycardia, junctional tachycardia, and ventricular arrhythmias including monomorphic ventricular tachycardia, polymorphic ventricular tachycardia, and ventricular fibrillation. Key features and mechanisms of each type are outlined to aid in diagnosis and classification.
This document presents information on various types of atrial arrhythmias. It discusses premature atrial complexes, atrial tachycardia, multifocal atrial tachycardia, atrial flutter, atrial fibrillation, and wandering atrial pacemaker. For each type, it covers etiology, characteristics, and treatment approaches. The document is presented by Baby Haokip from the College of Nursing, NEIGRIHMS.
This document provides an overview of AV nodal reentrant tachycardia (AVNRT) including its mechanisms, diagnosis using electrophysiology study techniques, and treatment with catheter ablation. It discusses the criteria for diagnosing dual AV nodal physiology, how AVNRT is initiated via programmed stimulation, its characteristic surface ECG patterns, and how the arrhythmia responds to different tests such as atrial and ventricular stimulation. The document emphasizes that AVNRT is the most common type of supraventricular tachycardia and is due to reentry involving slow and fast pathways in the AV node.
This document discusses electrophysiology (EP) studies and catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT). It describes the indications, equipment, and basic procedures for EP studies including catheter placement and recording intracardiac electrograms. It explains typical and atypical forms of AVNRT and how they are characterized during EP studies. It also outlines the mechanisms, techniques, success rates, and complications of slow pathway ablation for treating AVNRT.
This document defines and discusses the management of supraventricular tachyarrhythmias. It begins by defining terms like tachyarrhythmia, tachycardia, and supraventricular tachyarrhythmia. It then discusses various types of supraventricular tachycardias that arise from different areas of the heart including the sinoatrial node, atrioventricular node, atria, and accessory pathways. The document provides guidance on clinical evaluation, ECG patterns, mechanisms, and treatment approaches for common supraventricular tachycardias such as AV nodal reentrant tachycardia, AV reentrant tachycardia, atrial fibrillation, atrial flutter, and atrial
This document discusses the history and evidence for cardiac resynchronization therapy (CRT). It notes that approximately 25% of heart failure patients have intraventricular conduction delays that cause dyssynchronous contraction. CRT aims to resynchronize contraction by pacing both ventricles simultaneously. Randomized controlled trials found CRT improves symptoms, exercise capacity, and survival in patients with low ejection fraction and wide QRS. Guidelines recommend CRT for class III/IV heart failure patients with LBBB morphology and QRS >120ms. Some evidence also supports benefit in milder heart failure. Response can vary and not all patients respond equally.
Assessment of prosthetic valve functionSwapnil Garde
This document discusses the assessment of prosthetic valve function through various imaging modalities. It begins with an introduction to prosthetic valves and outlines topics to be covered, including classification of valve types. Evaluation methods like chest x-ray, fluoroscopy, echocardiography, and CT are described. Parameters assessed on each modality and guidelines for evaluation are provided. Complications of prosthetic valves and 3D imaging advances are also mentioned.
Diastolic heart failure occurs when the ventricles become stiff and cannot relax fully during diastole. This prevents full ventricular filling and blood backs up in the organs. Around half of heart failure patients have diastolic heart failure. Diagnosis relies on echocardiogram showing diastolic dysfunction. Treatment focuses on controlling hypertension, volume overload, and other causes through medications like ACE inhibitors, diuretics and beta blockers.
1. Rate control has equivalent efficacy to rhythm control for managing atrial fibrillation and has less drug-related side effects.
2. Drugs like digoxin, beta blockers, and calcium channel blockers can be used for rate control, while antiarrhythmics like amiodarone, dofetilide and sotalol are used for rhythm control.
3. Electrical cardioversion can be used to restore sinus rhythm but has a risk of recurrence, so anticoagulation is recommended afterwards to prevent stroke from clots that may form during the arrhythmia.
1) The EAST-AFNET trial compared an early rhythm control strategy to usual care for patients with recent-onset atrial fibrillation.
2) The early rhythm control strategy involved early use of antiarrhythmic drugs or ablation to maintain sinus rhythm, while usual care followed guidelines.
3) The trial was stopped early as early rhythm control reduced the composite outcome of death, stroke, or hospitalization compared to usual care over 5 years of follow-up.
The AFFIRM trial compared rate control and rhythm control strategies for treating atrial fibrillation. Over 7,000 patients with recurrent atrial fibrillation aged 65 or older were randomized to either rate or rhythm control. The primary outcome was overall mortality, with secondary outcomes including death from cardiovascular causes, stroke, bleeding, and hospitalization. The trial found no significant difference in mortality between the two groups. However, rhythm control was associated with greater need for hospitalization and higher rates of crossover to rate control. The study concluded that rate control should be the primary treatment approach for atrial fibrillation.
This document discusses various treatment options for atrial fibrillation (AF) including rate control, rhythm control, and anticoagulation. It summarizes the findings of the RACE II trial which showed that lenient rate control (resting heart rate up to 110 bpm) is not inferior to strict rate control (resting rate up to 80 bpm) for patients with permanent AF. It also reviews different pharmacological agents for rate control including beta-blockers, calcium channel blockers, and digoxin. Finally, it discusses rhythm control strategies such as antiarrhythmic drugs and catheter ablation for restoring and maintaining sinus rhythm.
This document provides guidance on guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF). It discusses initiation and titration of therapies including angiotensin receptor-neprilysin inhibitors, beta-blockers, sacubitril-valsartan, ivabradine, SGLT2 inhibitors, ACE inhibitors, ARBs, loop diuretics, and aldosterone antagonists. Key points include initiating therapies individually based on patient status, up-titrating doses every 2 weeks to maximize benefits, assessing for response using echocardiograms and biomarkers, and continuing GDMT even if ejection fraction improves to prevent heart failure events. Transcat
The AFFIRM trial compared rate control versus rhythm control strategies for treating atrial fibrillation among patients at high risk of stroke or death. It found that rhythm control did not provide a survival benefit over rate control, and was associated with some increased mortality. The trial demonstrated that rate control is a reasonable strategy for managing atrial fibrillation in high-risk patients.
1. The document discusses classification, management, and treatment of atrial fibrillation. It describes classification as paroxysmal, persistent, or permanent based on episode duration.
2. For stable patients, the first steps are evaluation, rate control if needed, and decision on cardioversion. For unstable patients, urgent cardioversion may be required. Electrical cardioversion is preferred but drugs can be used.
3. Anticoagulation for at least 3 weeks prior to and 4 weeks after cardioversion is recommended for episodes over 48 hours. For episodes under 48 hours, practices vary from anticoagulation in all to risk-based approaches.
This 40-year-old man presented with night sweats, hemoptysis, dyspnea and weight loss. Imaging showed a cavitary lung lesion and filling defects in the main pulmonary artery suggestive of a pulmonary embolism. Further PET-CT imaging and biopsy revealed primary pulmonary artery angiosarcoma. This is a rare and aggressive malignancy with poor prognosis. Treatment is largely palliative.
drug therapy in ventricular tachyarrhithmias in emergenciesEmergency Live
Antiarrhythmic drug therapy in patients with supraventricular or ventricular tachyarrhythmias in emergencies
Dietrich Andresen, Hans-Joachim Trappe*
Klinik für Kardiologie, Allgemeine Innere Medizin und konservative Intensivmedizin, Vivantes Klinikum am Urban und im Friedrichshain, Berlin, Germany;
*Medizinische Klinik II (Kardiologie und Angiologie), Ruhr-Universität Bochum, Herne, Germany
Atrial fibrillation is the most common arrhythmia and increases mortality risk. It is classified as paroxysmal, persistent, or permanent based on duration. The CHA2DS2-VASc score is used to assess stroke risk and determine need for anticoagulation. Treatment focuses on rate control with medications like calcium channel blockers or cardioversion for hemodynamic instability. Anticoagulation is recommended for CHA2DS2-VASc score over 2 to prevent stroke.
The TOMAHAWK trial compared outcomes of patients who experienced out-of-hospital cardiac arrest and received immediate coronary angiography versus the standard of care. The trial found that immediate angiography did not reduce all-cause mortality at 90 days compared to standard care. However, it did result in more patients being discharged from the hospital and fewer patients having severe neurological impairment.
The document describes several clinical trials related to atrial fibrillation (AF) management:
1. AFFIRM trial compared rate control vs rhythm control strategies and found no difference in mortality but rhythm control had better symptom control.
2. RecordAF registry found in real-world practice, rhythm control was preferred and had better therapeutic success rates than rate control.
3. RACE II trial showed lenient rate control (HR<110bpm) was not inferior to strict control (HR<80bpm) for cardiovascular outcomes in permanent AF.
4. ATHENA trial found dronedarone reduced cardiovascular hospitalizations in AF patients at high risk of events.
Timing dell' Ablazione della Fibrillazione atrialepasqualevergara1
Come implementare le linee guida per l’ablazione della fibrillazione atriale nella pratica clinica:
Precocità del trattamento per aumentare l’efficacia
Recnti trials hanno dimostrato che il trattamento precoce della fibrillazione atriale migliora gli outcomes, riduce la mortalità cardiovascolare e riduce il rischio di ictus
Atrial fibrillation in advanced heart failure role of rate controldrucsamal
1) Treating atrial fibrillation in patients with advanced heart failure remains a challenge due to the risks of both rate and rhythm control strategies.
2) Rate control is preferred over rhythm control, though strict heart rate targets may not be necessary, and beta blockers provide less clear benefit for rate control in AF patients with heart failure compared to those in sinus rhythm.
3) Antiarrhythmic drugs for rhythm control have been shown to increase risks of death and hospitalization, so non-pharmacological approaches and newer agents are being explored.
Atrial fibrillation is characterized by an irregular heartbeat and is classified as paroxysmal, persistent, or permanent based on duration. It is associated with risks like stroke and is diagnosed by ECG showing irregular rhythms. Treatment involves rate control with medications, anticoagulation based on stroke risk scores, and catheter ablation or antiarrhythmic drugs for rhythm control.
Management of hypertension hyperglycemia in strokeDr Pradip Mate
1. For patients with acute ischemic stroke who will receive thrombolytic therapy, antihypertensive treatment is recommended to lower blood pressure to ≤185/110 mmHg. Labetalol or nicardipine can be administered intravenously to achieve this.
2. For patients receiving reperfusion therapy, blood pressure should be maintained at ≤180/105 mmHg during and after treatment. It should be monitored frequently and medications adjusted as needed.
3. For previously untreated patients with a history of ischemic stroke or TIA, initiation of antihypertensive therapy is recommended if blood pressure remains ≥140/90 mmHg after the first few days, with a target of <140/90 mmHg
This document summarizes key points about atrial fibrillation (AF):
- AF is increasingly prevalent due to aging populations and risk factors like obesity. It reduces quality of life and accounts for a large portion of healthcare costs and strokes.
- Rhythm control strategies like catheter ablation have higher success rates than drug therapies and may slow or prevent progression of AF over time. Ablation also reduces risks of death, stroke, and dementia compared to drug therapy or no treatment.
- Advances in mapping systems and ablation catheters have improved safety and efficacy of catheter ablation procedures for treating AF.
Management of atrial fibrillation (summary)Adel Hasanin
Based on the guidelines presented in the document, the following procedures would not be considered or would fail for rhythm control in atrial fibrillation:
1. Percutaneous balloon cryoablation for pulmonary vein isolation in atrial fibrillation
2. Percutaneous endoscopic catheter laser balloon ablation
The document recommends left atrial catheter ablation or left atrial surgical ablation if drug treatment fails to control symptoms. It does not mention the above specific ablation procedures.
Dabigatran vs warfain Prior to TEE Journal ClubMichael Katz
1) The document summarizes a study comparing the direct thrombin inhibitor dabigatran to warfarin for preventing thromboembolic events after cardioversion for atrial fibrillation.
2) The study found the risk of stroke and major bleeding within 30 days of cardioversion was low and comparable between the two doses of dabigatran tested and warfarin, with or without transesophageal echocardiography guidance.
3) The results suggest dabigatran is a reasonable alternative to warfarin for preventing thromboembolic events in patients requiring cardioversion for atrial fibrillation.
Similar to Af rate vs rhythm control.samir rafla 2 (20)
This document discusses why every girl is a princess through her relationship with Jesus Christ. It provides six reasons:
1. As daughters of the King (Jesus), girls have inherent worth and should behave as princesses.
2. As ambassadors of Jesus, girls represent him through their conduct and behavior.
3. As servants of Jesus, girls should seek to help others in need on his behalf.
4. Jesus dwells within girls, so they can communicate with him intimately through prayer.
5. Jesus accepts friendship with people and is described as a friend in the Bible.
6. Girls are precious copies of Jesus, with people seeing him through their faces, speech and
This document summarizes recent advances in electrophysiology technologies:
1. New devices include dual chamber leadless pacemakers and a multi-electrode balloon catheter for radiofrequency ablation.
2. Subcutaneous ICDs eliminate transvenous leads, and a leadless CRT system is in development.
3. Improved ablation technologies include laser and radiofrequency balloon catheters.
4. Wearable and implantable devices are replacing Holter monitors for arrhythmia detection.
5. New electroanatomical mapping systems provide higher resolution maps.
6. MRI and ultrasound guidance are being used to visualize ablation effects.
7. Smartwatches can detect atrial fibrillation with E
1) Sudden cardiac death is a major public health problem, causing hundreds of thousands of deaths in the US each year. The most common causes are coronary artery disease and structural heart diseases.
2) Early recognition of SCD and initiation of cardiopulmonary resuscitation significantly improves chances of survival. Defibrillation within 5 minutes of cardiac arrest from ventricular fibrillation is critical.
3) New guidelines emphasize the importance of continuous chest compressions, use of automated external defibrillators, capnography to monitor CPR quality, and therapeutic hypothermia after resuscitation from cardiac arrest.
The document discusses junctional rhythms and disturbances. It describes how junctional rhythms can occur when retrograde conduction is impaired, resulting in AV dissociation with the ventricular rate usually faster than the atrial rate. An accelerated junctional rhythm is seen in patients with heart disease and is commonly caused by digitalis intoxication, acute myocardial infarction, surgery, or myocarditis. Occasionally, there can be exit block of the junctional impulse, slowing the ventricular rate. Junctional rhythms are evaluated based on the relationship between P waves and QRS complexes.
A beautiful paper published by Eugene Braunwald
European Heart Journal, Volume 42, Issue 24, 21 June 2021, Pages 2327–2328, https://doi.org/10.1093/eurheartj/ehab264
The document provides the 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation (AF) developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). It was created by the AF Task Force of the ESC with contributions from the EHRA. The Task Force included experts from various European countries who provided recommendations for the definition of AF, screening, diagnosis, assessment, and integrated management of AF patients. The guidelines represent an update based on recent clinical evidence and aim to improve diagnosis and optimize treatment strategies for AF.
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God created the heavens and the earth. Initially, the earth was formless and empty with darkness covering the deep. However, the Spirit of God was hovering over the waters. God then spoke light into existence and separated it from the darkness. He called the light "day" and the darkness "night," marking the first day. On the second day, God created an expanse to separate the waters above from the waters below, calling it the "sky."
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This summary provides the key details from the document in 3 sentences:
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The document provides background on the four Gospels of the New Testament - Matthew, Mark, Luke, and John. Though each Gospel was written separately, they all aim to convey God's favor toward humanity through Jesus Christ. The document then focuses on an overview of the Gospel of Matthew, summarizing each chapter in a few sentences to preview the key events and teachings contained therein, such as Jesus' birth, baptism, temptation, and beginning of his ministry.
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1. Atrial fibrillation (AF) is classified based on duration and presence of symptoms, including first diagnosed, paroxysmal (<7 days), persistent (≥7 days), long-standing persistent (≥12 months), and permanent.
2. Risk factors for incident AF include structural heart disease, hypertension, obesity, smoking, diabetes, and age.
3. Treatment recommendations include long-term antiarrhythmic drugs like amiodarone, dronedarone, and flecainide/propafenone based on patient characteristics, as well as cardioversion and catheter ablation.
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Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
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- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
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1. Atrial Fibrillation
Rate versus Rhythm Control
Samir Morcos Rafla, FACC, FESC, FHRS
Emeritus professor of cardiology
Alexandria University
smrafla@yahoo.com
Shorta Conference-Tolip Hotel-April 2019
2. Definitions
Paroxysmal AF is defined as recurrent AF ( 2
episodes) that terminates spontaneously within
seven days. Also lasting less than seven days
but necessitating pharmacologic or electrical
cardioversion.
Persistent AF is defined as AF which is
sustained beyond seven days. Included within
the category of persistent AF is ‘‘longstanding
persistent AF’’ which is defined as continuous
AF of greater than one year duration. The term
permanent AF is defined as AF in which
cardioversion has either failed or not been
attempted.
3. Atrial fibrillation (AF) is the most common
sustained arrhythmia. It may cause
significant symptoms and impair both
functional status and quality of life. Without
therapeutic intervention, affected patients are
at increased risk for mortality (1.5- to 1.9-fold
in the Framingham Heart Study) and
morbidity (thromboembolic events and
limiting symptoms).
3
4. In AF, the loss of the regular and organized
contraction of the left atrium as well as the
subsequent increase in ventricular rate, lead
to both immediate and long-term adverse
consequences: deterioration in
hemodynamics secondary to increased heart
rate and loss of atrioventricular (AV)
synchrony, an increased risk for stroke and
other embolic events from left atrial thrombi,
and progressive dysfunction of the left atrium
and left ventricle
4
10. Rhythm Control Versus Rate Control and Clinical
Outcomes in Patients With Atrial Fibrillation
Results From the ORBIT-AF Registry
JACC: Clinical Electrophysiology Volume 2, Issue 2, April 2016
Results The overall study population (N = 6,988) had
a median of 74 (65 to 81) years of age, 56% were
males, 77% had first detected or paroxysmal AF, and
68% had CHADS2 score ≥2. In unadjusted analyses,
rhythm control was associated with lower all-cause
death, cardiovascular death, first stroke/non–central
nervous system systemic embolization/transient
ischemic attack, or first major bleeding event (all p <
0.05); no difference in new onset heart failure
(p = 0.28); and more frequent cardiovascular
hospitalizations (p = 0.0006). 11
11. There was no difference in the incidence of
pacemaker, defibrillator, or cardiac resynchronization
device implantations (p = 0.99). In adjusted analyses,
there were no statistical differences in clinical
outcomes between rhythm control and rate control
treated patients (all p > 0.05); however, rhythm control
was associated with more cardiovascular
hospitalizations (hazard ratio: 1.24; 95% confidence
interval: 1.10 to 1.39; p = 0.0003).
Conclusions Among patients with AF, rhythm control
was not superior to rate control strategy for outcomes
of stroke, heart failure, or mortality, but was
associated with more cardiovascular hospitalizations.
12
12. Is rate more important than rhythm in
treating atrial fibrillation?
In addition to making the patient feel better, the
restoration of sinus rhythm may reduce the risk
of emergency hospital admission and stroke,
improve the ejection fraction, reduce atrial
remodelling, improve exercise capacity, and
improve outcome.
13
13. 14
STAF trial
Rhythm control by cardioversion and class I antiarrhythmic
agents or sotalol in the absence of coronary heart disease
and in patients with a normal left ventricular function versus
rate control using beta-blockers, digitalis, calcium channel
blockers or atrioventricular node ablation/modification.
Population:
Patients 18 years or older with one or more of following: AF
for >4 weeks; left atrial size >45 mm; congestive heart
failure, NYHA class II or greater; left ventricular ejection
fraction <45%; or ≥1 prior cardioversion with arrhythmia
recurrence.
Outcome
Death
Cardiopulmonary resuscitation
Cerebrovascular event; Systemic embolism
14. 15
PIAF trial
Rhythm control by amiodarone 600 mg for 3
weeks and then cardioversion if necessary.
Maintenance of sinus rhythm was attempted
by administration of amiodarone 200 mg/day
versus rate control diltiazem 90 mg two or
three times a day.
Patients 18–75 years presenting with
symptomatic persistent AF of between 7
days and 360 days duration.
15. Hot Café trial
Rhythm control by cardioversion prior to drug
treatment with propafenone, disopyramide,
or sotalol. Beta blockers were given if
clinically indicated versus rate control using
beta-blockers, digitalis, calcium channel
blockers or a combination of these drugs.
Cardioversion and atrioventricular ablation
with pacemaker placement were alternative
non-pharmacologic strategies.
16
16. CTAF trial:
Aggressive rhythm control: amiodarone and either sotalol
or dofetilide if required; electric cardioversion within 6
weeks after randomization in patients who did not have
conversion to SR after antiarrhythmic drug therapy; if
necessary a second cardioversion was recommended
within 3 months after enrolment; additional cardio-versions
were recommended for subsequent recurrences of AF;
installation of a permanent pacemaker was recommended
if bradycardia prevented the use of antiarrhythmic drugs
versus adjusted doses of beta blockers with digitalis to
achieve the targeted heart rate of less than 80 beats per
minute at rest and less than 110 beats per minute during a
6 minute walk test. AV nodal ablation and pacemaker
therapy were recommended for patients who did not meet
rate-control target with drug therapy. 17
17. AFFIRM trial:
Original Date of Publication: December 5, 2002
Rhythm control: Drugs chosen by the treating
physician and may include cardioversion.
Drugs could include amiodarone, disopyramide,
dofetilide, flecainide, procainamide, propafenone,
quinidine, sotalol and combinations of these drugs
versus rate control using beta-blockers, digoxin,
calcium channel blockers or a combination of these
drugs. Heart rate control during AF was assessed both
at rest and during activity, usually during a 6 minute
walk.
18
18. AFFIRM trial conclusions
1. Rate-control, along with anticoagulation,
should be the main approach to managing
patients with atrial fibrillation.
2. Compared to rhythm-control, rate-control
resulted in a lower incidence of adverse events
and no significant difference in mortality.
19
19. RACE trial
Rhythm control consisted of serial electrical
cardioversion with institution of antiarrhythmic
drugs (sotalol, class IC drugs including
flecainide or propafenone or amiodarone)
versus rate control was achieved using
negative chronotropic drugs including digitalis,
beta blocker and nondihydro-pyridine calcium
channel blocker.
20
20. 21
Economic evidence
Three studies compared the cost effectiveness of rhythm
control versus rate control in patients with AF.
Economic: Two cost–effectiveness analyses and one cost
utility analysis found that rate control was dominant (more
effective and less costly) when compared to rhythm control.
These analyses were assessed as partially applicable with
minor to potentially serious limitations.
Evidence statements: AF Clinical
Moderate quality evidence showed no difference between
rate and rhythm control in:
mortality (7 studies, N=6977)
bleeding (9 studies, N=12591)
Low quality evidence from six studies (N=7186) showed that
there may be no difference between rhythm and rate control
in: stroke; thromboembolic complications
21. Rate and rhythm control
When to offer rate or rhythm control
Offer rate control as the first-line strategy to people
with atrial fibrillation, except in people:
whose atrial fibrillation has a reversible cause
who have heart failure thought to be primarily caused
by atrial fibrillation
with new-onset atrial fibrillation
with atrial flutter whose condition is considered
suitable for an ablation strategy to restore sinus
rhythm
for whom a rhythm control strategy would be more
suitable based on clinical judgement.
22
22. Rate control: Offer either a standard beta-blocker (that
is, a beta-blocker other than sotalol) or a rate-limiting
calcium-channel blocker as initial monotherapy to
people with atrial fibrillation who need drug treatment as
part of a rate control strategy. Base the choice of drug
on the person's symptoms, heart rate, comorbidities
and preferences when considering drug treatment.
Consider digoxin monotherapy for people with
non-paroxysmal AF only if they are sedentary.
If monotherapy does not control symptoms, consider
combination therapy with any 2 of the following:
a beta-blocker; diltiazem; digoxin.
Do not offer amiodarone for long-term rate control.
23
23. Rhythm control: Consider pharmacological and/or
electrical rhythm control for people with AF whose
symptoms continue after heart rate has been
controlled or for whom a rate-control strategy has not
been successful.
Cardioversion: For people having cardioversion for
atrial fibrillation that has persisted for longer than
48 hours, offer electrical (rather than pharmacological)
cardioversion. Consider amiodarone therapy starting
4 weeks before and continuing for up to 12 months
after electrical cardioversion to maintain sinus rhythm,
and discuss the benefits and risks of amiodarone with
the person.
24
24. (Cont.) For people with atrial fibrillation of greater than
48 hours' duration, in whom elective cardioversion is
indicated:
both transoesophageal echocardiography
(TOE)-guided cardioversion and conventional
cardioversion should be considered equally effective
a TOE-guided cardioversion strategy should be
considered: where experienced staff and appropriate
facilities are available and where a minimal period of
precardioversion anticoagulation is indicated due to
the person's choice or bleeding risks.
25
25. Recommendations for rhythm control therapy
26
ClassRecommendations
IRhythm control therapy is indicated for symptom
improvement in patients with AF.
IIaManagement of cardiovascular risk factors and
avoidance of AF triggers should be pursued in patients
on rhythm control therapy to facilitate maintenance of
sinus rhythm.
IIaWith the exception of AF associated with haemodynamic
instability, the choice between electrical and
pharmacological cardioversion should be guided by
patient and physician preferences.
27. Recommendations for rate control
28
IBeta-blockers, digoxin, diltiazem,
or verapamil are recommended to
control heart rate in AF patients with
LVEF ≥40%.
IBeta-blockers and/or digoxin are
recommended to control heart rate
in AF patients with LVEF <40%.
IIaCombination therapy comprising
different rate controlling agents
should be considered if a single agent
does not achieve the necessary heart
rate target.
28. Recommendations for rate control (cont.)
29
In patients with haemodynamic instability or
severely depressed LVEF, amiodarone may be
considered for acute control of heart rate. Ilb
In patients with permanent AF (i.e. where no
attempt to restore sinus rhythm is planned),
antiarrhythmic drugs should not routinely be
used for rate control. III (harm)
29. Oral antiarrhythmic drugs used for maintaining
sinus rhythm after cardioversion
30
Main contra-indications and precautionsDoseDrug
Caution when using concomitant therapy with QT
prolonging drugs and in patients with SAN or AV
node and conduction disease. The dose of VKAs
and of digitalis should be reduced. Increased risk of
myopathy with statins. Caution in patients with pre-
existing liver disease.
600 mg in
divided doses for
4 weeks, 400 mg
for 4 weeks,
then 200 mg
once daily
Amiodarone
(Cordarone)
Contra-indicated in IHD or reduced LV ejection
fraction. Caution in the presence of SAN or AV
node and conduction disease, renal or liver
impairment, and asthma. Increases concentration
of digitalis and warfarin.
100–150 mg
twice daily
Propafenone
(Rytmonorm)
hypertrophy, systolic heart failure, asthma, pre-
existing QT Contra-indicated in the presence of
significant LV prolongation, hypokalaemia, CrCl<50
mg/mL Moderate renal dysfunction requires careful
adaptation of dose.
80–160 mg
twice daily
d,l sotalol
(Betacor)
31. Indications for Catheter Ablation
- Presence of symptomatic AF refractory or
intolerant to at least one Class 1 or Class 3
antiarrhythmic medication.
- In rare clinical situations, it may be
appropriate to perform catheter ablation of AF
as first line therapy. Catheter ablation of AF is
also appropriate in selected symptomatic
patients with heart failure and/or reduced
ejection fraction.
- The presence of a left atrial thrombus is a
contraindication to catheter ablation of AF.
32. 33
Cryo-ablation
In recent years, Cryoballoon (CB) ablation has become
the most efficient alternative to RF catheter ablation
(RFCA) for the treatment of AF (Fig. 9B). The
Cryoballoon (CB) single shot ablation approach to AF
has been designed to shorten and simplify the
ablation procedure for achieving an effective PVI.
Preclinical and clinical studies have shown that CB is
effective in achieving PVI, offering a valid alternative
to RF’s point-by-point approach to PAF treatment.
33. Indications for surgical AF ablation:
(1) Symptomatic AF patients undergoing other
cardiac surgery;
(2) Selected asymptomatic AF patients
undergoing cardiac surgery in whom the ablation
can be performed with minimal risk;
(3) Stand-alone surgery for AF should be
considered for symptomatic AF patients who
prefer a surgical approach, have failed one or
more attempts at catheter ablation, or are not
candidates for catheter ablation.
35. COMPLICATIONS OF CATHETER
ABLATION
Catheter ablation of AF is one of the most
complex interventional electro-physiological
procedures. It is therefore to be expected that
the risk associated with AF ablation is higher
than for ablation of most other cardiac
arrhythmias.
36
36. 37
Atrial Fibrillation
Rate versus Rhythm Control
For each patient with AF, the two principal goals of
therapy are symptom control and the prevention of
thromboembolism.
Rate- and rhythm-control strategies improve
symptoms, but neither has been conclusively shown
to improve survival compared to the other.