This document discusses the management of atrial fibrillation. It notes that AF prevalence is increasing with an aging population and is associated with increased risk of stroke and mortality. Treatment involves rate or rhythm control with medications, electrical cardioversion, or newer options like catheter ablation. Risk stratification tools like CHADS2 are used to determine stroke risk and need for anticoagulation. Newer oral anticoagulants offer alternatives to warfarin by avoiding the need for INR monitoring.
Early and effective treatment of patients with acute coronary syndrome saves lives. Lot of progress has been made in last few years in understanding patho-physiology and management of these patients.
* Lois physiques de l'apnée
* Physiologie de l'apnée avec un langage simple adapté au grand publique
* Différentes disciplines de l'apnée
* Accidents liés à l'apnée avec des recommandations de bonnes pratiques
Early and effective treatment of patients with acute coronary syndrome saves lives. Lot of progress has been made in last few years in understanding patho-physiology and management of these patients.
* Lois physiques de l'apnée
* Physiologie de l'apnée avec un langage simple adapté au grand publique
* Différentes disciplines de l'apnée
* Accidents liés à l'apnée avec des recommandations de bonnes pratiques
Nouvelles technologies, réseaux sociaux et épidémiologie : l’exemple de la co...Guy Fagherazzi
Présentation aux Rencontres Santé Publique France 2016 à Paris. Mardi 7 juin 2016.
Session "Big data : intérêts et limites pour une utilisation en prévention et en épidémiologie"
Les données produites par les utilisateurs des objets connectés ou des réseaux sociaux comme Facebook ou Twitter sont en pleine expansion. Toutes ces données peuvent être mises au service de la santé publique : surveillance sanitaire, pharmacovigilance, communication, prévention mais pour quels résultats, sous quelles conditions et avec quels risques ?
La publication des résultats de l’essai nord américain « Women’s Health Initiative » (WHI) en juillet 2002 a transformé le paysage du traitement hormonal de la ménopause (THM), remettant en question un rapport bénéfices/risques considéré jusqu’à cette date comme nettement favorable. Les augmentations induites par le THM du risque cardiovasculaire et du risque de cancer du sein, démontrées par cet essai, ont conduit les agences européennes du médicament, dont l’Afssaps, à restreindre les indications du THM. L’objectif de ce travail, demandé et financé par l’Afssaps, était de décrire en France, après juillet 2002, l’évolution du recours au THM chez des femmes récemment ménopausées, en termes de fréquence et de nature des traitements utilisés.
Accidents graves de plongée sous marine saarsiu 2016Islem Soualhi
Auteur : Dr M.I.SOUALHI
Co-auteur : Dr S.A.NAAMANI*, Pr K. GUENANE
La plongée sous-marine en apnée ou en scaphandre connait un essor croissant ces dernières années, si en Algérie le nombre de licenciés est de plus de 5000, de ce fait les accidents en rapport apparaissent.
Parmi les accidents qu’on rencontre en plongée les accidents de désaturation restent rare en plongée loisir, mais occupent une place importante chez les plongeurs corailleurs de la région Est d’Algérie qui font des plongées hors normes et sans mesures de sécurité pour récolter le corail rouge.
L’accident de désaturation est une forme d’embolie gazeuse liée à un gaz inerte (N2) qui peut mettre en jeu le pronostic vital ou fonctionnel du plongeur
This presentation describes the epidemiology, initial assessment, investigation and emergency department management of a patient with atrial fibrillation. Some new research evidences are also discussed to answer some dilemmas.
A comprehensive approach to Atrial Fibrillation. Everything you need to know about Atrial fibrillation. Including recent 2014 AHA guidelines of management.
During atrial fibrillation, the heart's upper chambers — called the atria — beat chaotically and irregularly. They beat out of sync with the lower heart chambers, called the ventricles. For many people, AFib may have no symptoms. But AFib may cause a fast, pounding heartbeat, shortness of breath or light-headedness.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Management of Atrial Fibrillation Science:Myths & Fashion
1. Management of Atrial FibrillationScience, Myths and Fashion What you need to know as a community practitioner Dr Duncan Hogg Consultant Cardiologist, Aberdeen Royal Infirmary.
2. Atrial FibrillationScience, Myths and Fashion By the end of this talk I hope you will: Have increased understanding of the epidemiology & pathophysiology of atrial fibrillation (AF) Recognise the clinical consequences of AF. Understand the different treatment options in AF Be aware of current & future developments.
3. Atrial Fibrillation: Epidemiology AF is the commonest cardiac dysrhythmia. Estimated to affect 5% of the population over 60 years & increasing to 10% over 75 years old. Likely to become more prevalent with an ageing population and their increased exposure to pre-disposing cardiovascular disease. Wolf et al. Secular trends in the prevalence of atrial fibrillation: The Framingham Study. Am Heart J 1996;131:790-795.
4. AF: Costs to the Health Care System 1985-1990, 35% of all arrhythmia hospitalizations had principal diagnosis of atrial fibrillation. Average hospital stay = 5 days. Other AF-related provision include: Outpatient reviews and day-case cardioversions Anti-arrhythmic drugs & INR monitoring AF-induced strokes. The significant cost to the healthcare system is clear. Geraets DR. Clin Pharm. 1993;12:721-735.
5. Cardiac risk factors for AF Independent risk factors for AF include- Male gender, hypertension, diabetes, LV systolic (& diastolic) dysfunction, any valvular disease. Hypertension now more responsible than any other. AF also associated with any structural abnormality e.g all forms cardiomyopathies, tumours (atrial myxoma), or acute insults e.g. pericarditis, post cardiac surgery, myocardial infarction. Kannel et al. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol 1998;82:2N-9N.
6. Non-cardiac risk factors for AF Non-cardiac causes of AF include: Pulmonary: Any acute or chronic lung disease e.g. COPD, pneumonia, pulmonary embolism Metabolic: Hyperthyroidism, electrolyte disorder Toxic: Alcohol, acute & chronic systemic illness. “Lone AF”. Those AF patients with absence of identifiable cardiovascular, or acute systemic insult or disease:
7. Electrophysiology of AF AF is caused by multiple circulating wavelets of excitation around the cardiac atria.
8. Electrophysiology of AF Atrial fibrillation is triggered into existence. Single initiator or the interaction of many e.g. supraventricularectopy, myocardial ischaemia, left atrial stretch due to pressure or volume load. Atrial myocardium electrically remodels increasing the stability of AF- ‘AF begets AF’. Later pathological remodelling (left atrium fibrosis) permanently affects the atrias’ electrical conductivity.
9. Electrophysiology of AF 2 broad overlapping electrophysiological groups Patients with normal hearts generally have a ‘trigger-predominant’ initiation. Patients with abnormal hearts generally have a ‘substrate-predominant’ initiation. Therapeutic potentials may differ between these two, particularly with respect to potential for AF ablation.
10. ‘3P’ classification of AF AF first detected Paroxysmal AF (Self-terminating) Persistent AF (Non self-terminating) Permanent AF Gallagher & Camm. Classification of atrial fibrillation. PACE 1997;20:1603-1605.
11. Clinical: Mortality of AF Relative risk of stroke & mortality in patients with AF cf in SR
12. Clinical: Mortality of AF Excess mortality in patients with AF is linked with severity of underlying heart disease eg CHF. AF can facilitate the induction of ventricular arrhythmias eg Wolf-Parkinson-White. Iatrogenic- anti-arrhythmic drugs (AADs) used for AF can be pro-arrhythmic and anticoagulants can cause fatal haemorrhagic events.
13. Clinical: Morbidity of AF Two aspects of patient morbidity in AF Thromboembolic risk and Cardiovascular symptoms
14. Thromboembolism in AF Atrial fibrillation can be a prothrombotic state. AF is associated with an increased risk of stroke or thromboembolism (TE) of 1-17% per annum, depending on co-existent risk factors e.g. age >65yrs, hypertension, diabetes, left ventricular dysfunction (LVD) or mitral valve disease. Exact causes of thrombus formation not clear.
16. AF thrombus formation in LAA Virchows’ triad Loss of ordered atrial contraction produces turbulent blood flow within the cardiac atria. Fibrillating atria can activate the endothelium. The turbulent blood flow & endothelial activation of AF can produce platelet activation.
17. Stroke prevention in AF Aspirin & warfarin have been studied in AF thromboembolic prophylaxis. Warfarin has strongest evidence for both primary & secondary prevention. The SPAF (stroke prophylaxis in AF) investigators suggested prescription of warfarin to those at high thromboembolic risk.
18. Stroke prevention in AF From meta-analysis of thrombo-prophylaxis trials the overall benefit of treatment was- Warfarin (INR 1.8-2.6) reduces risk of AF thrombo-embolic event by 66%. Aspirin (75-300mg) reduces risk of AF thrombo-embolic events by 25%. (Clopidogrel alone, probably equivalent to aspirin)
22. Thrombo-embolic risk stratification Balancing the risks and benefits of warfarin: No warfarinif: HAS-BLED > CHADS2 or HAS-BLED >2 in CHADS2 0/1 HAS-BLED >3 in CHADS2 2 Using this algorithm would reduce >10% of major bleeds
23. AF cardiovascular morbidity At least 40% of patients are asymptomatic at initial detection of AF. Most patient symptoms are at the onset of AF and/ or related to exertion. Symptoms are predominately caused by the elevated resting heart rate and rapid increase associated with exertion.
24. Ventricular rate control in AF AADs for ventricular rate (VR) control should aim to address VR at rest and on exertion. ß-blockers, calcium channel blockers if no concern of left ventricular dysfunction (LVD). If LVD, digoxin or amiodarone can be 1st line. NB. digoxin does not control VR on exertion. Choice of rate or rhythm control management.
25. Rhythm control of AF Remains no evidence that restoration of SR is beneficial in reducing patient mortality or morbidity. The PIAF study assessed rhythm or rate control effects on patient symptoms or QoL. No difference in QoL assessment despite statistically better 5 min walking test in rhythm control group. Rhythm or rate control in AF- Pharmacological Intervention in Atrial Fibrillation: a randomised trial. Lancet 2000;356:1789-94.
26. Rhythm control of AF The AFFIRM study found no benefit in overall mortality, thromboembolic events, 6-minute walk or QoL in rhythm control patients. Decision on rhythm or rate control is guided by patient symptoms & clinic parameters for success in maintaining SR for example: Longevity of AF, LA size, LVD & MVD. The AFFIRM investigators. NEJM 2002;347:1825-33.
27. Rhythm control options for AF Pharmacological conversion is most often effective for recent onset AF i.e. <48 hrs. Many small studies for acute onset AF, but in a randomised comparison flecainide > propafenone > amiodarone (~90%) (~ 70%) (~ 60%) Amiodarone best (10-15%) for persistent AF
29. Electrical cardioversion (DC-CV) DC-CV has a high initial success rate but high probability of future relapse to AF. AADs differ in SR post DC-CV maintainenance Van Gelder et al., Arch Intern Med 1996;156:2585–92.
30. Maintaining SR post DC-CV In CTAF study amiodarone > sotalol/propafenone Debated whether sotalol has extra benefit over regular ß-blockers; potential pro-arrhythmic by QT prolongation. Class I AAD (flecainide, propafenone) reduce relapse and often used in combination with ß-blockers. Calcium channel blockers have modest benefit alone. Canadian trial of atrial fibrillation (CTAF). NEJM 2000;342:913-20.
31. Electrical cardioversion in AF Without warfarin DC-CV associated with a significant risk of thrombo-embolic events, most in 2-10 days; significantly reduced risk with warfarin, but even with therapeutic INR about 1 in 200/250. Elevation of thrombotic markers post DC-CV, probably due to ‘atrial stunning’. phenomenon of atrialasystole in SR post DC-CV. Optimal duration of warfarin post DC-CV still unclear.
32. Current & near future new options in AF management Holy grail of ‘cleaner amiodarone’ is now very close to reality with Dronedarone, after many false starts. An oral direct thrombin inhibitor (DTIs) ie ‘warfarin without monitoring’ is (again) almost ready for use having been assessed versus warfarin. Percutaneous occlusion of the left atrial appendage. Electrophysiological cure increasingly possible in a selected number of AF patients.
33. ‘Cleaner amiodarone’, the holy grail?! Dronedarone (Multaq, Sanofi-Aventis) appears to lack many of the extra-cardiac side-affects of amiodarone. It seems effective in reducing paroxysms of AF and maintaining SR post cardioversion c.f. placebo. Concerns remain in significant heart failure and/or LVD of ventricular pro-arrhythmias (prolongs QT interval). Many potential drug interactions (CYP3A4 drugs) with potential for induction of torsades de pointes. Cost.............
34. No more INRs in AF patients? First oral DTI Ximelagatran (Exanta,AstraZeneca), which was non-inferior to dose-adjusted warfarin in prevention of all strokes and systemic embolic events in non-valvular AF patients. The combined rate of major and minor bleedings was significantly lower for ximelagatran c.f warfarin. Concerns of transient LFT derangement lead to it not reaching the market for its AF indication.
35. No more INRs in AF patients? Dagibatran (Pradaxa, Boehringer Ingelheim), has received FDA approval for AF thrombo-prophylaxis RE-LY study was randomised, open-label study non-inferiority study assessing two doses 110mg & 150mg. 110mg had similar rate of stroke cf warfarin with significantly reduced major bleeding. 150mg had reduced risk of stroke cf warfarin with similar risk of major bleeding. Less ICH c.f. warfarin. No liver toxicity; GI upset main s-a.
36. No more INRs in AF patients? Dagibatran currently costs ......... Other oral DTIs in various stages of development: apixaban (Bristol-Myers Squibb/Pfizer), rivaroxaban (Xarelto, Bayer/Johnson & Johnson); doxaban (Daiichi-Sankyo); and, betrixaban (Portola Pharmaceuticals/Merck). This congested field may well bring the cost down.
37. High stroke risk but high bleeding risk - stop thrombus forming in appendage Sievert et al Circulation 2002;105:1887-1889
38. Percutaneous closure of appendage Left atrial angiogram: after trans-septal puncture and LAA cannulation, contrast injection outlines LAA from which an ostial diameter can be measured; contrast injection via a lumen through the implant reveals hang up of dye behind the sealing surface, indicating proper position and occlusion; after device release, contrast injection in the LA establishes complete seal.
39. Ablation: a cure for AF? Haissaguerre M.et al. Spontaneous initiation of AF by ectopic beats originating in the pulmonary veins. N Engl J Med 1998; 339: 659-666
41. Ablation: a cure for AF? CS, coronary sinus; LUPV, left upper pulmonary vein; RUPV, right upper pulmonary vein; RA isthmus line, right atrial isthmus line. CT angiogram of the posterior aspect of the left atrium. Red lines indicate lines of electrical conduction block .
42.
43. Ablation: a cure for AF? Substrate evolution leads to a change in ablation technique AF type: Paroxysmal Persistent Permanent Role of pulmonary veins: Role of muscle & scar: Ablation: PVI Substrate & hybrid
44. Summary of AF management Prevalence, hospitalisation and healthcare costs for AF are increasing. Thrombo-embolic risk stratification by CHADS2 score for all patients: not everybody needs warfarin. Rate control can be achieved with many drugs: but aim to control resting and exertional heart rate. Sinus is worth pursuing in many patients with AF, those that are symptomatic and likely to maintain SR.
45. Summary of AF management AADs are essential to reduce the risk of relapse to AF post DC-CV: ß-blockers & amiodarone. Dronedarone is a possible replacement for amiodarone Oral thrombin inhibitors “warfarin without the monitoring” are on the verge of replacing warfarin, but at what cost is not currently certain. AF catheter ablation can cure selected AF patients particularly paroxsymal, accepting procedural risks.
46. Atrial FibrillationScience, Myths and Fashion Hopefully now you will: Have increased understanding of the epidemiology & pathophysiology of atrial fibrillation (AF) Recognise the clinical consequences of AF. Understand the different treatment options in AF. Be aware of future developments including ablation.
47. Management of Atrial FibrillationScience, Myths and Fashion What you need to know as a community practitioner Dr Duncan Hogg Consultant Cardiologist, Aberdeen Royal Infirmary.