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ATRIAL FIBRILLATION

Diagnosis & Management

Zainuddin Khan
SMF Kardiologi dan Kedokteran Vaskular
RSUD Tarakan, Jakarta

Introduction
Atrial Fibrillation Facts
- Most common cardiac arrhytmia
- Incidence : 1 2%
- Increased prevalence with age
- Public health problems

ESC Guidelines. Eur Heart


J. 2010

CLINICAL EVENTS AND


OUTCOME OF AF

ESC Guidelines. Eur Heart

DEFINITION AND
DIAGNOSIS
AF Cardiac arrhytmia with the
following characteristics :
Absolutely irregular RR intervals
No distinct P wave on the surface ECG
Rapid and irregular ventricular response

ESC Guidelines. Eur Heart


J. 2010

ETIOLOGY AND RISK FACTORS

ESC Guidelines. Eur Heart


J. 2010

PATHOGENESIS

TYPES OF ATRIAL FIBRILLATION

ESC Guidelines. Eur Heart

CLINICAL IMPACT
Rapid ventricular rate
Progressive ventricular dysfunction
Rate related cardiomyopathies
Loss of atrial transport decreased CO
Irregular ventricular depolarizations
decreased CO
Inappropriate rate increases with
exercise
Activation of platelet and the coagulation
system thromboembolic complications

EHRA score of AF- related


symptoms

ESC Guidelines. Eur Heart

THERAPY GOALS AND


TREATMENTS
Rate control Reduce symptoms and rate
related cardiomyopathies
Rhythm control Restoration and
maintenance of normal sinus rhythm
Risk reduction Reduce the risk of stroke
Symptom reduction Improve quality of
life

DCC and pharmacological conversion


recent-onset AF

ESC Guidelines. Eur Heart


J. 2010

The management cascade for


patients with AF

ESC Guidelines. Eur Heart


J. 2010

Rate control of atrial fibrillation

hoice of drugs depends on life style and underlying di

ESC Guidelines. Eur Heart

Drugs and doses for pharmacological


conversion of (recent-onset) AF

ESC Guidelines. Eur Heart


J. 2010

STROKE PREVENTION

STROKE PREVENTION

Risk factors for stroke and


thrombo-embolism in non-valvular AF

ESC Guidelines. Eur Heart


J. 2010

Risk factor-based point-based scoring


system - CHA2DS2-VASc

ESC Guidelines. Eur Heart

Use of oral anticoagulation for


stroke prevention in AF

ESC Guidelines. Eur Heart

Approach to thrombo Prophylaxis in AF

ESC Guidelines. Eur Heart


J. 2010

CONCLUSION
AF is the most common form of cardiac
arrhythmia
Responsible for public health problems
Causing some clinical implications
The main therapy goals are:
- reduce symptoms and rate-related
cardiomyopathy as well as reduce
the risk of
stroke
Modalities of treatment : Drugs, DCC and
catheter ablation

THANK YOU