Current Mangement of Atrial Fibrillation An .

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m on Dec 05, 2012 Says :

GREAT jOB!!! DR. MONIKA J...

Juan on Jun 03, 2011 Says :

Excellent and very didactic material. Wonderful job

on Dec 18, 2009 Says :

Excellent set of slides on AF managemnt. Dr Vijayaraghavan

ghaliah on Oct 31, 2009 Says :

great job

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Slide 1 :

John D. Hummel, MD Ohio State University Medical Center Ross Heart Hospital Columbus, Ohio Current Mangement of Atrial Fibrillation: An Evidence-Based Approach

Slide 2 :

Learning Objectives Understand the guidelines for anticoagulation and where there is latitude for physician decisionmaking. Be able to discriminate between patients requiring restoration of sinus rhythm vs. rate control alone. Be able to determine when patients should be evaluated for curative ablation.

Slide 3 :

Atrial Fibrillation Easily recognized. Seems to bother healthcare workers as much as patients. Who’s Problem? Internists cardiologists EP.

Slide 4 :

Go A, et al. JAMA. 2001;285:2370-2375. Projected Number of Adults With AF in the US: 1995 to 2050.

Slide 5 :

Atrial Fibrillation: Costs to the Health Care System 35% of arrhythmia hospitalizations Average hospital stay = 5 days Mean cost of hospitalization = $18,800 Does not include: Costs of outpatient cardioversions Costs of drugs/side effects/monitoring Costs of AF-induced strokes Estimated US cost burden 15.7 billion ALOT!!

Slide 6 :

Paroxysmal (Self-terminating) First Detected Permanent Classification of Atrial Fibrillation ACC/AHA/ESC Guidelines Persistent (Not self-terminating)

Slide 7 :

DIAGNOSTIC WORKUP Minimum Evaluation History and physical – Sx with AF, CV dz Electrocardiogram – WPW, BBB, LVH, MI Echocardiogram – LVH, LAE, EF, Valve Dz Labs – TSH, Renal fxn, LFTs Additional Testing ETT – CAD, Exercise induced SVT / AF Holter / Event Monitor – Confirm AF and Sxs TEE – LA clot EPS – SVT triggered AF AHA / ACC / ECS Guidelines 2006

Slide 8 :

Maintenance of SR Pharmacologic Stroke prevention Nonpharmacologic Class IA Class IC Class III ?-blocker Catheter ablation Surgery (MAZE) Pacing Pharmacologic Warfarin Thrombin inhibitor Aspirin Nonpharmacologic Removal / isolation LA appendage Rate control Pharmacologic Ca2+ blockers ?-blockers Digitalis Amiodarone Nonpharmacologic Ablate and pace Prevent remodeling ACE-I ARB AF: TREATMENT OPTIONS Adapted from Prystowsky, Am J Cardiol. 2000;85:3D-11D.

Slide 9 :

Risk Factors for Thromboembolism in AF High-Risk Factors Recommended Therapy Previous CVA / TIA / Embolism High-risk factor or > 2 Mitral Stenosis moderate-risk factors Prosthetic heart valve Coumadin INR 2-3 Moderate-Risk Factors (mechanical valve INR > 2.5) Age > 75 yrs HTN 1 moderate-risk factor CHF ASA or Coumadin DM EF < 35% No risk factors Weaker-Risk Factors ASA 81-325mg daily Female CAD Thyrotoxicosis Age 65 – 74 yrs AHA / ACC / ECS Guidelines 2006

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