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By: Nicholas B.

Sianipar

GUIDELINES FOR THE MANAGEMENT OF ATRIAL FIBRILLATION (ESC 2010)

Nicholas B. Sianipar

Nicholas B. Sianipar

Introduction
Atrial fibrillation (AF) is the most common

sustained cardiac arrhythmia, occurring in 1 2% of the general population. Over 6 million Europeans suffer from this arrhythmia, and its prevalence is estimated to at least double in the next 50 years as the population ages. AF confers a 5-fold risk of stroke, and one in five of all strokes is attributed to this arrhythmia.
Nicholas B. Sianipar

Epidemiology
AF affects 12% of the population, and this

figure is likely to increase in the next 50 years. The prevalence of AF increases with age, from <0.5% at 4050 years, to 515% at 80 years. Men are more often affected than women.

Nicholas B. Sianipar

Nicholas B. Sianipar

Cardiovascular and other conditions associated with atrial fibrillation


Ageing Hypertension

Symptomatic heart failure

Tachycardiomyopathy

Valvular heart diseases

Cardiomyopathies

Atrial septal defect

Other congenital heart defects

Coronary artery disease

Thyroid dysfunction

Obesity

Diabetes mellitus

COPD

Sleep apnoea (OSA)

Chronic renal disease


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Mechanisms of atrial fibrillation

Nicholas B. Sianipar

Definition of AF
The surface ECG shows absolutely irregular RR intervals (AF is therefore sometimes known as

arrhythmia absoluta), i.e. RR intervals that do not follow a repetitive pattern. There are no distinct P waves on the surface ECG. Some apparently regular atrial electrical activity may be seen in some ECG leads, most often in lead V1. The atrial cycle length (when visible), i.e. the interval between two atrial activations, is usually variable and <200 ms (>300 bpm).
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Nicholas B. Sianipar

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Management

Antithrombotic Rate and rhythm


Long-term Upstream therapy
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Antithrombotic management

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Antithrombotic management

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Antithrombotic management

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Antithrombotic management

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Rate and rhythm management

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Long-term management

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Long-term management

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Long-term management

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Upstream therapy

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Why should you use ACEi/ARB?


LV hemodynamics Atrial stretch / dilation

VHD, HF, HT, CAD

Activates RAAS

AF

Fibrosis

production of connective tissue growth factor

Increase Angiotensin II & TGF-1

Electrical & structural remodeling

Inducing & maintaining AF

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TERIMA KASIH, SEMOGA BERMANFAAT.

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