Sabri DEMIRCAN Istanbul Bilim University Department of Cardiology

Transcription

1 abri DEMIRCN Istanbul Bilim University Department of Cardiology

2 H/CC/HR Guideline for the Management of Patients With trial Fibrillation. J m Coll Cardiol 4;64:46-8.

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4 European Heart Journal () 3,

5 Nattel, et al. J m Coll Cardiol 4;63:335 45

6 Electrical F (trigger dependent F Electroanatomic F (trigger and substrat dependent F) natomical F (substrat dependent, role of trigger is less) Mahnkopf C, et al: Evaluation of the left atrial substrate in patients with lone atrial fibrillation using delayed-enhanced MRI: Implications for disease progression and response to catheter ablation, Heart Rhythm 7:475 48,

7 European Heart Journal () 3,

8 European Heart Journal () 3,

9 EHR Class Explanation EHR I No symptoms EHR II Mild symptoms ; normal daily activity not affected EHR III evere symptoms ; normal daily activity affected EHR I Disabling symptoms ; normal daily activity discontinued European Heart Journal () 3,

10 Outcome Death troke (includes haemorrhagic stroke and cerebral bleeds) Hospitalizations Quality of life and exercise capacity Left ventricular function Relative Change in F patients Death rate doubled troke risk increased; F is associated with more severe stroke Hospitalizations are frequent in F patients and may contribute to reduced quality of life Wide variation, from no effect to major reduction. F can cause marked distress through palpitations and other F-related symptoms Wide variation, from no change to tachycardiomyopathy with acute heart failure European Heart Journal () 3,

11 ymptoms troke prevention Decreasing of hospitalizations Improvement of quality of life and exercise capacity urvive

12 6 y, male Palpitation despite of amiodarone and sotatol No syncope No history of known heart disease Family history: CD - Normal physical examination

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14 Echocardiography: L dilatation and dysfunction Holter recording: Multiple short episodes of wide and narrow QR tachycardia Failed T ablation (T not inducible) Cardiac MR diagnosis: Non-compaction Recommendation: ICD

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22 fter 4 months; No palpitation and any arrhythmia (Holter) Echocardiography; LEDD : 6 mm (57 mm) LED : 47 mm (4 mm) LEF : 47 % (5 %) L diam : 47 mm (4 mm) PP : 4 mmhg (7 mmhg)

23 64 y, male patient Dyspnea 3 hospitalizations and cardioversion because of decompensation related with persistent F after CRT upgrade in year History; 998 MI, multiple PCI - DDD-ICD implantation (paroxysmal F,, node disease, systolic dysfunction and inducible T) CRT-D upgrade (Heart failure, continue P, severe MR) Improvement in EF and clinical status after upgrade

24 Treatment; Ramipril 5 mg Metoprolol x 5 mg pironolacton 5 mg Warfarin torvastatin Furosemide D Treatment; Long term amiodarone (hypothyrodism) otalol Propafenone

25 Echocardiography; EF: 4-45 % (54/43 mm) Left atrium diameter: 4 mm PP: 35 mmhg (+) MR

26 9995 oftware ersion 7.3 Copyright Medtronic, Inc. 6 7-Feb- 6:3:6 Pa T B T D T D T D T D B T D T D T D T D B T D T D T D Waveform suspended for 5 min T D T D B T D T D T D P B T D T D P B T D P B T D T D B R R R R B R R R R B R R B b R R C E R B C D P P B P B

27 4 Jan Mar May Jul ep Nov Jan Heart rate variability (ms) > 6 8 <4 Jan Mar May Jul ep Nov Jan 9995 oftware ersion 7.3 Cardiac Compass Rep Copyright Medtronic, Inc. 6 Page Printed: 7-Feb- 6:

28 max/day avg/day 5 <5 % Pacing/day trial entricular vg. rate (bpm) Day Night > 8 6 <4 Patient activity hours/day 4 3 Jan Mar May Jul ep Nov Jan 9995 oftware ersion 7.3 Cardiac Compass R Copyright Medtronic, Inc. 6 Page Printed: 7-Feb- 6:

29 European Heart Journal () 3,

30 Testa L et al, European Heart Journal 5; 6: 6

31 European Heart Journal ; 33:79-747

32 H/CC/HR Guideline for the Management of Patients With trial Fibrillation. J m Coll Cardiol 4;64:46-8.

33 H/CC/HR Guideline for the Management of Patients With trial Fibrillation. J m Coll Cardiol 4;64:46-8.