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Atrial Fibrillation European Heart Journal 2010 European Heart - PowerPoint PPT Presentation

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ESC Guidelines 2010 on the management of Atrial Fibrillation European Heart Journal 2010 European Heart Rhythm Association (EHRA); Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS) www.escardio.org/guidelines European

  1. ESC Guidelines 2010 on the management of Atrial Fibrillation European Heart Journal 2010 European Heart Rhythm Association (EHRA); Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS) www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  2. www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  3. Classes of recommendations www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  4. Levels of evidence www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  5. Clinical Events (outcomes) affected by AF www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  6. Conditions predisposing to, or encouraging progression of AF www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  7. Types of Atrial Fibrillation www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  8. Clinical evaluation www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  9. Structural abnormalities associated with AF www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  10. EHRA score of AF- related symptoms AF = atrial fibrillation; EHRA = European Heart Rhythm Association www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  11. Natural time course of AF AF = atrial fibrillation www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  12. Diagnosis and initial management of AF a Class of recommendation. b Level of evidence. AF = atrial fibrillation; ECG = electrocardiogram; EHRA = European Heart Rhythm Association. www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  13. Diagnosis and initial management of AF a Class of recommendation. b Level of evidence. AF = atrial fibrillation; ECG = electrocardiogram. www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  14. Diagnosis and initial management of AF a Class of recommendation. b Level of evidence. AF = atrial fibrillation; ECG = electrocardiogram. www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  15. The management cascade for patients with AF ACEI = angiotensin-converting enzyme inhibitor; AF = atrial fibrillation; ARB = angiotensin receptor blocker; PUFA = polyunsaturated fatty acid; TE = thrombo-embolism. www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  16. CHADS 2 score and stroke rate *The adjusted stroke rate was derived from the multivariable analysis assuming no aspirin usage; these stroke rates are based on data from a cohort of hospitalised AF patients, published in 2001, with low numbers in those with a CHADS 2 score of 5 and 6 to allow an accurate judgement of the risk in these patients. Given that stroke rates are declining overall, actual stroke rates in contemporary non-hospitalised cohorts may also vary from these estimates. Adapted from Gage BF et al. AF = atrial fibrillation; CHADS 2 = cardiac failure, hypertension, age, diabetes, stroke (doubled). www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  17. Risk factors for stroke and thrombo-embolism in non-valvular AF AF= atrial fibrillation; EF = ejection fraction (as documented by echocardiography, radionuclide ventriculography, cardiac catheterization, cardiac magnetic resonance imaging, etc.); LV = left ventricular; TIA = transient ischaemic attack. www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  18. Risk factor-based point-based scoring system - CHA 2 DS 2 -VASc *Prior myocardial infarction, peripheral artery disease, aortic plaque. Actual rates of stroke in contemporary cohorts may vary from these estimates. www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  19. Adjusted stroke rate according to CHA 2 DS 2 -VASc score www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  20. Use of oral anticoagulation for stroke prevention in AF AF = atrial fibrillation; OAC = oral anticoagulant; TIA = transient ischaemic attack. www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  21. Approach to thromboprophylaxis in AF AF = atrial fibrillation; CHA 2 DS 2 -VASc = cardiac failure, hypertension, age ≥ 75 (doubled), diabetes, stroke (doubled)- vascular disease, age 65 – 74 and sex category (female); INR = international normalized ratio; OAC = oral anticoagulation, such as a vitamin K antagonist (VKA) adjusted to an intensity range of INR 2.0 – 3.0 (target 2.5). www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  22. The HAS-BLED bleeding risk score *Hypertension is defined as systolic blood pressure > 160 mmHg. INR = international normalized ratio. www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  23. Cardioversion, TOE and anticoagulation AF = atrial fibrillation; DCC = direct current cardioversion; LA = left atrium; LAA = left atrial appendage; OAC = oral anticoagulant; SR= sinus rhythm; TOE= transoesophageal echocardiography. www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  24. Prevention of thromboembolism in AF www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  25. Prevention of thromboembolism in AF www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  26. Prevention of thromboembolism in AF a Class of recommendation. b Level of evidence. AF = atrial fibrillation; CHADS2 = cardiac failure, hypertension, age, diabetes, stroke (doubled); INR = international normalized ratio; LMWH = low molecular weight heparin; OAC = oral anticoagulant; TIA = transient ischaemic attack; VKA = vitamin K antagonist. www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  27. Drugs and doses for pharmacological conversion of (recent-onset) AF ACS = acute coronary syndrome; AF = atrial fibrillation; DCC = direct current cardioversion; i.v. = intravenous; N/A = not applicable; NYHA, New York Heart Association; p.o. = per os; QRS = QRS duration; QT = QT interval; T-U = abnormal repolarization (T-U) waves. www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  28. DCC and pharmacological conversion recent-onset AF AF = atrial fibrillation; i.v. = intravenous. www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  29. Pharmacological cardioversion of AF a Class of recommendation. b Level of evidence. AF = atrial fibrillation; LoE = level of evidence; i.v. = intravenous. www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  30. DC cardioversion for AF a Class of recommendation. b Level of evidence. AF = atrial fibrillation; DCC = direct current cardioversion. www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  31. General Management of the AF Patient www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  32. Choice of rate and rhythm control strategies www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  33. Rate and rhythm control of AF a Class of recommendation. b Level of evidence. AF = atrial fibrillation; EHRA = European Heart Rhythm Association. www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  34. Optimal level of heart rate control www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  35. Rate control of atrial fibrillation The choice of drugs depends on life style and underlying disease www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  36. Drugs for rate control ER = extended release formulations; N/A = not applicable. ‡ Only in patients with non-permanent atrial fibrillation. www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  37. Acute rate control in AF a Class of recommendation. b Level of evidence. AF = atrial fibrillation; i.v. = intravenous. www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  38. Long-term rate control in AF a Class of recommendation. b Level of evidence. AF = atrial fibrillation; bmp = beats per minute; LV = left ventricular; NYHA = New York Heart Association. www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  39. Long-term rate control in AF a Class of recommendation. b Level of evidence. AF = atrial fibrillation; bmp = beats per minute; LV = left ventricular; NYHA = New York Heart Association. www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  40. AV node ablation in AF patients a Class of recommendation. b Level of evidence. AF = atrial fibrillation; AV = atrioventricular; CRT = cardiac resynchronization therapy; LV = left ventricular; LVEF = left ventricular ejection fraction; NYHA = New York Heart Association. www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

  41. AV node ablation in AF patients a Class of recommendation. b Level of evidence. AF = atrial fibrillation; AV = atrioventricular; CRT = cardiac resynchronization therapy; LV = left ventricular; LVEF = left ventricular ejection fraction; NYHA = New York Heart Association. www.escardio.org/guidelines European Heart Journal (2010) 31, 2369-2429

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