atrial fibrellation update

Atrial Fibrillation-update

Fathi Maklady, MD , FRCPProfessor of Cardiovascular medicine

Suez Canal University

Atrial Fibrillation-update

• AF is the most common sustained cardiac arrhythmia In the general population.1-2%

• It is estimated to be doubled in the next 50Yrs as the population ages.

AF-Epidemiology

• -<0.5% age 40-50

• -2-4% age 50-60

• -6-8% age 60-70

• -10-15% age>80

AF-Definition

• Rapid and uncoordinated irregular atrial activation with loss of contribution of atrial contraction to ventricular filling ,The end result is a decrease in cardiac output.

AF-risk

AF-Risk

• Life time risk of developing AF is 25% in those reached the age of 4oYrs.

• Paroxysmal AF carries the same risk as persistent or permanent AF.

• Asymptomatic or silent AF accounts for about 30% ,and may cause cryptogenic stroke.

CV conditions associated with AF

• -Age• -Hypertension.• -Heart Failure.• -Tachycardiomyopathy.• -Valvular Heart disease.• -Coronary artery disease.• -Cong Heart disease.• -Cardiomyopathies.

CV conditions associated with AF

• Aging :due to isolation of atrial myocardium and conduction disturbance.

• Heart failure:-AF is found in 30-40% of HF Pts.• Pts with HF-NHHA 11-1V is found in 30% of AF

Pts.• Valvular HT disease are found in 30% of Pts

with AF due to Lt atrial distension.• Cardiomyopathy is found in 10% of AF Pts.

CV conditions associated with AF

• ASD is associated with AF in 10-15% of Pts.

• Other cong HT disease :single ventricle,transposition,fontan surgery.

• CAD is present In >20% of AF Pts.

Non CV conditions associated with AF

• Thyroid dysfunction: hyper-Hypo-subclinical.

• Obesity: is found in25% of AF Pts.

• Diabetes: is found in 20%.

• COPD :in 10-15%.

• CKD:in 10-15%

• OSA.

AF-Types

1. First diagnosed AF2. Paroxysmal: self terminated usually within

48h ,It may continue up to 7days.3. Persistent: when AF lasts longer than 7 days

or need termination by cardioversion.4. Long standing persistent :AF lasted more than

a year ,when it is decided to adopt rhythm control strategy.

5. Permanent AF:The presence of AF accepted by the patient ad physician ,and rhythm control is not pursued.

Evaluation of a Pt with AF

Evaluation of a Pt with AF

• History :very important

Evaluation of a Pt with AF

• Clinical Examination: -BP -Character of apex -LVH Or HF manifestation. -Valvular Ht disease. -Congenital Ht disease. -Other non cardiac problems eg,thyroid

dysfunction, COPD,Obesity…etc

Evaluation of a Pt with AF

1. Routine:FBC, SC, FBS,Electrolytes,LFTs

2. TSH

3. Echocardiography: structural or functional abnormalities.

AF-ECG Criteria

1. Shows absolutely irregular R-R interval (arrhythmia absoluta)

2. No distinct P wave.

3. Atrial cycle length 200-300 b/m

Predisposing Factors for Recurrence

• -Age.

• -Lt Atrial size.

• -Reduced LVF.

• Presence of CAD.

• Presence of valvular Ht disease. Duration of AF before cardioversion.

• Number of recurrence.

AF Management

AF Management

• The Goal:

1. Reduce Symptoms.

2. Prevent complications.

AF Management

1. Reduce symptoms: -Rhythm control by antiarhythmic,electric

cardioversion ,or ablation.

2. Preventing complications: -Antithrombotic therapy -Control of ventricular rate -Adequate therapy for concomitant

cardiac disease

AF Management

• Rate Control vs Rhythm Control

Prevention of Thromboembolic Complications

Non Warfarin Therapy

In-Conclusion

Copyright ©2011 American Heart Association

2011 Writing Group Members, et al. Circulation 2011;123:104-123

Therapy to maintain sinus rhythm in patients with recurrent paroxysmal or persistent atrial fibrillation

THANK YOU