atrial fibrillation update 2012 dr c seifer section of cardiology st boniface hospital
TRANSCRIPT
Atrial Fibrillation Atrial Fibrillation Update 2012Update 2012
Dr C SeiferDr C Seifer
Section of CardiologySection of Cardiology
St Boniface HospitalSt Boniface Hospital
Case 1Case 1
86 yo female86 yo female Hypertension and Coronary Artery Hypertension and Coronary Artery
DiseaseDisease > 10 year history of persistent (permanent) > 10 year history of persistent (permanent)
atrial fibrillationatrial fibrillation Difficult to rate controlDifficult to rate control Admitted with CHF and atrial fibrillation Admitted with CHF and atrial fibrillation
with ventricular rate 120-130 bpmwith ventricular rate 120-130 bpm
Case 1Case 1
LVEF (MUGA) 27%LVEF (MUGA) 27% On metoprolol 100 mg TID and On metoprolol 100 mg TID and
amiodarone 200 mg daily (nausea)amiodarone 200 mg daily (nausea)
Case 1Case 1
What next?What next?
Case 1Case 1
What next?What next? Increase/Add medicationsIncrease/Add medications No further interventionNo further intervention Consider pacing and AV node ablationConsider pacing and AV node ablation
Case 1Case 1
What next?What next? Increase/Add medicationsIncrease/Add medications No further interventionNo further intervention Consider pacing and AV node ablationConsider pacing and AV node ablation
Case 1Case 1
What next?What next? Increase/Add medicationsIncrease/Add medications No further interventionNo further intervention Consider pacing and AV node ablationConsider pacing and AV node ablation
Anticoagulation?Anticoagulation?
Can J of Cardiol 2012;28:125-136.
Can J of Cardiol 2012;28:125-136.
Case 2Case 2
76 yo female 12 hours post hip 76 yo female 12 hours post hip replacementreplacement
History of hypertension and DM2History of hypertension and DM2 Symptoms of palpitationsSymptoms of palpitations HR 140 bpm and BP 140/80HR 140 bpm and BP 140/80 ECG confirms atrial fibrillationECG confirms atrial fibrillation
Case 2Case 2
ManagementManagement
Case 2Case 2
ManagementManagement
Rhythm control?Rhythm control? Rate control?Rate control?
Case 2Case 2
ManagementManagement
Rhythm control?Rhythm control? Rate control?Rate control?
• MetoprololMetoprolol• DiltiazemDiltiazem
Case 3Case 3
48 yo male 48 yo male Attends for physicalAttends for physical Denies any significant symptoms symptoms but Denies any significant symptoms symptoms but
not very active (truck driver)not very active (truck driver) HR 100 bpm irreg irreg BP 130/80HR 100 bpm irreg irreg BP 130/80 ECG confirms atrial fibrillationECG confirms atrial fibrillation Started on ASA and atenololStarted on ASA and atenolol ECHO: Mildly dilated LA, normal left ventricleECHO: Mildly dilated LA, normal left ventricle
Case 3Case 3
What next?What next? Rhythm controlRhythm control Rate controlRate control
Case 3Case 3
What next?What next? Rhythm controlRhythm control
• D/C cardioversionD/C cardioversion• ± Antiarrhythmic drugs± Antiarrhythmic drugs
Rate controlRate control
Case 4Case 4
54 yo healthy male54 yo healthy male Two episodes of symptomatic atrial fibrillation in Two episodes of symptomatic atrial fibrillation in
the past 1 yearthe past 1 year No other co-morbiditiesNo other co-morbidities Started on Metoprolol and FlecainideStarted on Metoprolol and Flecainide Two subsequent episodes of AF – one requiring Two subsequent episodes of AF – one requiring
D/C cardioversionD/C cardioversion Started on amiodarone – hyperthyroidStarted on amiodarone – hyperthyroid No structural heart diseaseNo structural heart disease
Case 4Case 4
What next?What next?
Case 4Case 4
What next?What next?
Another drug trialAnother drug trial No change in managementNo change in management Pacemaker and AV node ablationPacemaker and AV node ablation Ablation (PVI)Ablation (PVI)
Case 4Case 4
What next?What next?
Another drug trialAnother drug trial No change in managementNo change in management Pacemaker and AV node ablationPacemaker and AV node ablation Ablation (PVI)Ablation (PVI)
Can J of Cardiol 2012;28:125-136.