Atrial fibrillation

• • Cardiology #2 Gimadeeva A.D.

Atrial fibrillation

• Cardaic arrhythmia that involves the two upper chambers (atrias) of the heart beat irregularly or quiver • 1 in 25 people aged 60 and older • 10% of people over 80 having AF • 15-20% of all strokes

Classification

• Paroxysmal-first detected episode self terrminates in less than 7 days • Persistent-episodes lasts for more than 7 days • Permanent-episode is ongoing for a long time

Signs & Symptoms

• Palpitation • Exersize intolerance • Angina • Shortness of breath, edema

ECG

Echocardiography

• Identify valvular heart disease • Left &right atria size • Left ventricular size & function • Peak right ventricular pressure • Presense of left ventricular hypertrophy • Pericardial disease

Transesophageal echocardiography • Prefer when planning urgent electrical cardioversion for identifying thrombi & sluggish bloodflow • Best visualisation of appandage place,where thrombus most commonly is formed

Etiology

• High blood pressure • Heart disease-coronary artery disease,mitral stenosis,mitral regurgitation, hypertrophic cardiomyopathy, pericarditis, heart surgery,congenital heart disease • Lung disease • Holiday heart syndrom • Hyperthyroidism • Carbon monoxide poisoning • Dual-chamber pacemakers in the presense of normal AV-conduction

Goals of treatment

To restore regular heart rate medications,cardioversion,RFA To control the heart rate- digoxin,BB To prevent blood clots forming & causing strokes-Warfarin, Pradaxa, closure Watchman

Anticoagulation therapy

• • • Risk of thromboembolic events CHADS2 score (2001) CHA2DS2-VAS score (European guidelines) • • Risk of bleeding HAS-BLED score (2010)

For patients with CHA2DS2-VAS score of 2 or greater & HAS-BLED score of <3 anticoagulation • CHA2DS2-VAS • CHF or EF<35% • AGE>75 -2p • DM • Prior TIA,CVA or emboli • Vascular-prior PVD or MI • Age 65-75-1 p • Sex-female 1p • HAS-Bled score • Hypertension>160mmhg • Abnormal kidney or liver function • Stroke • Bleeding history • Labile INR(in range<60%) • Elderly >65 • Drugs(ASA,Plavix),>8 drink/week

• Pradaxa ,Dabigratan • Direct thrombin inhibitors • 110mg 2x • 150 mg 2x • Warfarin • INR 2-3

Thanks for attention