Atrial Firbrilation rubayet

1. 2016 ESC Guidelines for
the management of atrial
fibrillation
Dr. Khandaker Abu Rubaiyat
MD Cardiology Thesis Part Student
Department of Cardiology
DMCH

2. Introduction
Despite good progress in the management of patients
with atrial fibrillation (AF), this arrhythmia remains one
of the major causes of stroke, heart failure, sudden
death, and cardiovascular morbidity in the world.
Furthermore, the number of patients with AF is predicted
to rise steeply in the coming years. To meet the growing
demand for effective care of patients with AF, new
information is continually generated and published, and
the last few years have seen substantial progress.
Therefore, it seems timely to publish this 2nd edition of
the ESC guidelines on AF.

3. Common problems with AF in CCU/OPD
• Stroke + AF
• Bleeding + AF
• AMI + AF
• Stent/PCI + AF
• AF + VKA/NOAC
• Pregnancy + AF

4. DO NOTs in AF management -
(14) Do not use antiplatelet therapy for stroke prevention in AF.
(15) Do not permanently discontinue oral anticoagulation in AF
patients at increased risk of stroke unless such a decision is
taken by a multidisciplinary team.
(16) Do not use rhythm control therapy in asymptomatic AF
patients, nor in patients with permanent AF.
(17) Do not perform cardioversion or catheter ablation without
anticoagulation, unless an atrial thrombus has been ruled out by
transoesophageal echocardiogram.

7. Management Plan

8. Rate control therapy in atrial
fibrillation

13. Rhythm control therapy in atrial
fibrillation

14. Rhythm control management of recent onset atrial fibrillation

16. Initiation of long term rhythm control therapy in symptomatic
patients with atrial fibrillation

20. Stroke prevention in atrial fibrillation

21. Tell Me Now…..
 Mr. Abdur Rahman
 56 years old
 H/O AMI (Anterior)
 Normotensive with medication
 Taking Tab. Metformin for 6 years
 ECG – AF
 Echo – LVEF 38%
 So, the CHA2DS2VASC Score ?

25. Characteristics of approved Non-vitamin K
antagonist oral anticoagulants

26. Secondary stroke prevention

30. Recommendations for management of
bleeding

31. What is HASBLED?
• H -
• A -
• S -
• B -
• L -
• E -
• D -

32. What is HASBLED?
• H – Hypertension
• A – Abnormal renal/liver function
• S – Stroke
• B – Bleeding history or predisposition
• L – Labile INR
• E – Elderly pt. (> 65 years)
• D – Drugs/Alcohol concomitantly

36. Combination therapy with oral anticoagulants
and antiplatelets

41. Common problems with AF in CCU/OPD
• Stroke + AF
• Bleeding + AF
• AMI + AF
• Stent/PCI + AF
• AF + VKA/NOAC
• Pregnancy + AF

46. THANK YOU