Joint ESC/ACC/AHA Guidelines 2006

1
Atrial Fibrillation (Management of Patients
with)

• Joint ESC/ACC/AHA Guidelines 2006
• Developed in collaboration with the European
  Heart Rhythm Association (EHRA) and the Heart
  Rhythm Society (HRS)

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Atrial Fibrillation

• Supraventricular tachyarrhythmia characterized by
  uncoordinated atrial activation with consequent
  deterioration of mechanical function
• Most common sustained cardiac rhythm disturbance
• 2.3 mill. N.America, 4.5 mill EU parox AF/
  persist AF
• Prevalence increases with age
• Often associated with structural heart disease
• Acute temp causes etoh, hyperthyr, surgery,
  peri-/myocarditis, MI, PE, pulm.dis, metabolic,
• Haemodynamic impairment and thromboembolic events
  result in significant morbidity, mortality, cost

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Patterns of Atrial Fibrillation

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Management strategies

• Rate control
• no commitment to restore or maintain SR
• beta bl., diltiazem, verapamil HF digox
  acc.pw amiodar
• Prevention of thromboembolism
• antithrombotic therapy recommended to all AF,
  exc.lone AF or CI
• agent based upon risk of stroke/bleeding
• Correction of rhythm disturbance (?)
• restoration and/or maintenance of sinus rhythm
• also requires attention to rate control

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Prevention of thromboembolism

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Cardioversion of AF recommendations

• AF rapid VR HD-instability DC-cardioversion
• AF rapid VR angina, HT, HF no prompt
  response to pharm. Measures DC-cardioversion
• rhythm control (pharmacological and
  DC-cardioversion !)
• lt 48h duration, anticoagulation before/after
  according risk
• gt 48h/unknown duration
• antico 3w prior to and 4w after
• TOE no thrombus, antico during and 4w after
• consider AAD-pretreatment (if safe!)
• Interruption of antico for procedures
• antico may be interrupted for up to 1 wk without
  heparin-subst
• mechanical prosthetic valves prior stroke/TIA
  (lmw)heparin subst