Gestione del primo episodio di fibrillazione atriale . In ambulatorio arriva un paziente con FA non nota: gestione territoriale o invio in ospedale?

1. Milano con il cuore in mano
Pasquale Vergara MD, Ph-D
San Raffaele Hospital
Milano – Italy
In ambulatorio arriva un paziente con FA
non nota:
gestione territoriale o invio in ospedale?

2. Atrial fibrillation

3. • Diagnosis
• Structured characterization
• ABC management
• Anticoagulation
• Better symptom management
• Cardiovascular & comorbidity optimization
An itinerary in Atrial Fibrillation

4. Diagnosis of Atrial Fibrillation ESC Guidelines 2020
⇝ When AHRE/subclinical AF is detected by a device/wearable, inspection
of the stored electrograms/ECG rhythm strips is recommended to
exclude artefacts or other causes of inappropriate detection

5. Towards a structured characterization of AF ESC Guidelines 2020

6. People involved in AF patients’ care ESC Guidelines 2020

7. AF Management based on symptoms
Haemodynamically stable
Haemodynamically
unstable
• Syncope
• Symptomatic hypotension
• Acute HF, pulmonary oedema
• Ongoing myocardial ischemia
• Cardiogenic shock

8. Diagnostic work-up and follow-up in AF patients ESC Guidelines 2020

9. • Diagnosis
• Structured characterization
• ABC management
An itinerary in Atrial Fibrillation

10. A Anticoagulation/Avoid stroke
B Better symptom management
C Cardiovascular & Comorbidity
optimization
Patient management: the integrated ABC pathway ESC Guidelines 2020

11. ‘A’ Anticoagulation ESC Guidelines 2020
Low molecular weight heparin
⇝offer stroke prevention in
» male with CHADS-VASC≥1
» female with CHADS-VASC≥2

12. » active serious bleeding
» recent high-risk bleeding event such as intracranial
haemorrhage (ICH)
» severe thrombocytopenia <50 platelets/lL
» severe anaemia under investigation
The few absolute contraindications to OAC: ESC Guidelines 2020

13. ‘B’ Better symptom control
Rate control
ESC Guidelines 2020

14. ‘B’ Better symptom control
Rhythm control
ESC Guidelines 2020

15. Obesity and weight loss
Alcohol and caffeine use
Physical activity
Specific cardiovascular risk factors/comorbidities
Hypertension
Heart failure
Coronary artery disease
Diabetes mellitus
Sleep apnoea
‘C’ Cardiovascular risk factors & concomitant diseases ESC Guidelines 2020

16. I pazienti con FA non emodinamicamente tollerata vanno
immeditamente inviati in Ospedale
In ambulatorio arriva un paziente con FA non nota:
gestione territoriale o invio in ospedale?
Nei pazienti con FA emodinamicamente tollerata la
caratterizzazione ed il management possono essere iniziati sul
territorio
Anticoagulazione , Rate control
Il successive management richiede l’interazione tra gestione
territoriale ed Ospedale

17. Milano con il cuore in mano
Pasquale Vergara MD, Ph-D
San Raffaele Hospital
Milano – Italy
In ambulatorio arriva un paziente con FA
non nota:
gestione territoriale o invio in ospedale?