The Role of ACEI and ARBs in AF prevention

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "The Role of ACEI and ARBs in AF prevention"

Transcription

1 The Role of ACEI and ARBs in AF prevention Dr. Sameh Shaheen MD, FESC Prof. of cardiology Ain-Shams university Time course of atrial substrate remodeling in relation to the clinical appearance of AF and proposed interventions to slow or arrest the remodeling process. ١

2 Atrial fibrillation is increasing Age-specific prevalence (per 1 population) of hospitalizations for atrial fib among adults age 35 yrs or older by year, 1985 to 1999 Concomitant Heart Failure: 13 % age yrs 21% age > 65 yrs Wattigney, W. A. et al. Circulation 23;18: Prevalence of Diagnosed AF Stratified by Age & Sex Errors bars represent 95% confidence intervals. Numbers represent the number of men and women with AF in each age category. ٢

3 Incidence of at least 1 episode of AF in hypertensive subjects in sinus rhythm sorted by LV hypertrophy at echocardiography. Age-adjusted 5-year risk of chronic AF in hypertensive subjects in sinus rhythm. Reported values are the 3 division points for quartiles. ٣

4 2% of patients with heart failure develop AF within 4 yrs Unadjusted cumulative incidence of first AF after Heart Failure - Framingham Study Development of AF was associated with increased mortality: hazard ratio of 1.6 (95% CI, 1.2 to 2.1) in men and 2.7 (95% CI, 2. to 3.6) in women. Wang, T. J. et al. Circulation 23;17: Atrial fibrillation: prevalence increases with severity of heart failure % Patients with Atrial Fibrillation SOLVD Pre Solv Rx V-HeFT II CHF STAT CIBIS II Elite AVID Diamond Gesica OPTIME Consensus Class I II Class III - IV ٤

5 Relative risk of stroke and mortality in patients with AF compared with patients without AF. Framingham Heart Study (Kannel et al. Coronary heart disease and atrial fibrillation: the Framingham Study. Am Heart J 1983;16:389 96) ARBs reduce AF by suppressing structural remodelling Sustained atrial fibrillation induced in 2 dogs by rapid pacing of right atrium for 5 weeks Control Candesartan Percentage Interstitial fibrosis ** p <.1 vs control *** p <.1 vs control *** Se econds Duration of atrial fibrillation ** Kumagai et al. J Am Coll Cardiol 23;41: ٥

6 ACE I and ARB prevent electrical remodelling in pacing model of AF Conclusions The inhibition of endogenous Ang II prevented atrial effective refractory period (AERP) shortening during rapid atrial pacing. Nakashima H et al. Circulation 2; 11: LIFE Echo Sub study: Losartan had a Greater Reduction in LVMI 96 patients ) ange in LVMI (g/m 2 ) Ch -5 Losartan Atenolol Last Years * 21% greater than Atenolol *p=.11 Adapted from Devereux et al Circulation 24;11: ٦

7 LIFE Echo Sub study: Losartan leads to more LA diameter reduction Mean left atrial diameter at baseline and at annual echocardiograms Atenolol Losartan *P <.1 vs baseline within group Hypertension Journal Feb 27 Adapted from Gerdts et al (Hypertension. 27;49: ) New-Onset AF Pr roportion of patients with first event (%) RR:.67 [95% CI:.55.85], p<.1 Adjusted RR:.67 [95% CI:.55.85], p< Time (months) Atenolol (n=4182) Losartan (n=4298) 33% P<.1 Adapted from Wachtell K et al J Am Coll Cardiol 25;45: ٧

8 The Kaplan Meier curves of percentage of patients remaining free of first occurrence of AF during 2.9 years of follow-up in 374 patients with depressed LV function (EF 35%) and sinus rhythm at baseline, randomly assigned to enalapril (solid line) or placebo (dotted line). From the SOLVD trials. Valsartan Reduces AF in CHF The Val-HeFT Study Variable Valsartan Placebo p Sample NYHA II-III 98.2% 97.7% - Hx of AF 12% 12.2% New AF 5.12% 7.95% Probability of AF Placebo Valsartan Age > 7 yrs Male gender BNP > 97 pg/ml Valsartan 1.51 ( ) 1.53 ( ) 2.28 ( ).63 (.49.81) Months Atrial fibrillation ill (AF) Congestive Heart Failure (HF) No AF AF Maggioni AP et al. Am Heart J 25;149: ٨

9 Enalapril reduces recurrent AF 21-23, n = 145 Scheduled DC shock Randomization Amio alone Amio + Enalapril 2 mg Pre-treatment 4 weeks Follow-up 27 d Conclusion The addition of enalapril to amiodarone decreased the rate of immediate and subacute arrhythmia recurrences and facilitated subsequent longterm maintenance of sinus rhythm after cardioversion of persistent AF. %1 f r o m r e c u r r e n c e, F r e e f LA > 4 cm Amio+Enap LA 4 cm Amio Amio+Enap Amio 2 4 W: HR.31 [ ], p =.26 LA > 4 cm: HR.48 [ ], p= Months Ueng KC et al. EHJ 23; 24: Madrid et al.: Addition of irbesartan to amiodarone in reducing recurrence of AF 1..9 amiodarone 4 mg + irbesartan 15/3 mg (n= 79).8.7 Patients free of recurrences (%) amiodarone 4 mg (n= 75).2.1 Log Rank p= n=186 Follow-up (days) Inclusion criteria: Patients with persistent AF Primary endpoint: the length of time to first recurrence of AF Madrid AH et al. Circulation 22; 16: ٩

10 Pre-treatment with Irbesartan attenuates left atrial stunning after electrical cardioversion of AF LAAEV in the Irbesartan group (left) and in the control group (right) before (pre), immediately after (post) cardioversion, and at 2 weeks (2 wks) Nikolaos Dagres. EHJ 26 27(17): Conclusion A clinically significant reduction in AF is seen in patients treated with either ACEIs or ARBs. The reduction in AF with ACEIs and ARBs appears to be related, in part, to the hemodynamic effects of these drugs, although these two classes of agents may also possess specific properties that help prevent AF. It is premature to recommend an ACEI or ARB solely for the prevention or treatment of AF, but these data raise the possibility of an added benefit in patients receiving either agent for HF or hypertension. 27 Guidelines for the Management of Hypertension ١٠

HF and CRT: CRT-P versus CRT-D

HF and CRT: CRT-P versus CRT-D HF and CRT: CRT-P versus CRT-D Andrew E. Epstein, MD Professor of Medicine, Cardiovascular Division University of Pennsylvania Chief, Cardiology Section Philadelphia VA Medical Center Philadelphia, PA

More information

All in the Past? Win K. Shen, MD Mayo Clinic Arizona Controversies and Advances in CV Diseases Cedars-Sinai Heart Institute, MFMER

All in the Past? Win K. Shen, MD Mayo Clinic Arizona Controversies and Advances in CV Diseases Cedars-Sinai Heart Institute, MFMER ICD for NICM All in the Past? Win K. Shen, MD Mayo Clinic Arizona Controversies and Advances in CV Diseases Cedars-Sinai Heart Institute, 2017 2017 MFMER 3686275-1 DISCLOSURE Relevant Financial Relationship(s)

More information

Do All Patients With An ICD Indication Need A BiV Pacing Device?

Do All Patients With An ICD Indication Need A BiV Pacing Device? Do All Patients With An ICD Indication Need A BiV Pacing Device? Muhammad A. Hammouda, MD Electrophysiology Laboratory Department of Critical Care Medicine Cairo University Etiology and Pathophysiology

More information

Atrial Fibrillation Ablation in Patients with Heart Failure

Atrial Fibrillation Ablation in Patients with Heart Failure Atrial Fibrillation Ablation in Patients with Heart Failure Eleftherios M. Kallergis, MD, PhD, FESC Cardiology Department, Heraklion University Hospital Since auricular fibrillation so often complicates

More information

Atrial Fibrillation and Heart Failure: Rate vs. Rhythm Control Time for Re-evaluation

Atrial Fibrillation and Heart Failure: Rate vs. Rhythm Control Time for Re-evaluation Atrial Fibrillation and Heart Failure: Rate vs. Rhythm Control Time for Re-evaluation ANIL K. BHANDARI, M.D, Director, Electrophysiology and EPS Fellowship Program Good Samaritan Hospital/ Harbor UCLA

More information

Management of Stage B Heart Failure

Management of Stage B Heart Failure KSC 2017 Management of Stage B Heart Failure Byung Su Yoo, MD., PhD. Division of Cardiology, Wonju College of Medicine, Yonsei University, South Korea Focused on Symptom ASLVSD, ASLVDD LVH HF progression

More information

The Hearth Rate modulators. How to optimise treatment

The Hearth Rate modulators. How to optimise treatment The Hearth Rate modulators How to optimise treatment Munich, ESC Congress 2012 Prof. Luigi Tavazzi GVM Care&Research E.S. Health Science Foundation Cotignola, IT Disclosure Cooperation with: Servier, Medtronic,

More information

Update on pharmacological treatment of heart failure. Aldo Pietro Maggioni, MD, FESC ANMCO Research Center Firenze, Italy

Update on pharmacological treatment of heart failure. Aldo Pietro Maggioni, MD, FESC ANMCO Research Center Firenze, Italy Update on pharmacological treatment of heart failure Aldo Pietro Maggioni, MD, FESC ANMCO Research Center Firenze, Italy Presenter Disclosures Dr. Maggioni : Serving in Committees of studies sponsored

More information

ESC Guidelines for the Diagnosis and Treatment of Chronic Heart Failure

ESC Guidelines for the Diagnosis and Treatment of Chronic Heart Failure ESC Guidelines for the Diagnosis and Treatment of Chronic Heart Failure - 2005 Karl Swedberg Professor of Medicine Department of Medicine Sahlgrenska University Hospital/Östra Göteborg University Göteborg

More information

12 th Annual Biomarkers in Heart Failure and Acute Coronary Syndromes: Diagnosis, Treatment and Devices. Heart Rate as a Cardiovascular Biomarker

12 th Annual Biomarkers in Heart Failure and Acute Coronary Syndromes: Diagnosis, Treatment and Devices. Heart Rate as a Cardiovascular Biomarker 12 th Annual Biomarkers in Heart Failure and Acute Coronary Syndromes: Diagnosis, Treatment and Devices Heart Rate as a Cardiovascular Biomarker Inder Anand, MD, FRCP, D Phil (Oxon.) Professor of Medicine,

More information

Atrial Fibrillation. Wat ur di-n 2 no. Ned Gutman 6 August, 2009

Atrial Fibrillation. Wat ur di-n 2 no. Ned Gutman 6 August, 2009 Atrial Fibrillation Wat ur di-n 2 no Ned Gutman 6 August, 2009 2 goals in treating AF Alleviation of symptoms Reduce risk of stroke Anticoagulation CHADS score Future anticoagulants Rate vs Rhythm control

More information

Fibrillazione atriale e scompenso: come interrompere il circolo vizioso.

Fibrillazione atriale e scompenso: come interrompere il circolo vizioso. Alessandria, September 23 th 2017 Fibrillazione atriale e scompenso: come interrompere il circolo vizioso. Professor Fiorenzo Gaita Chief of the Cardiovascular Department Città della Salute e della Scienza

More information

Heart Failure with preserved ejection fraction (HFpEF)

Heart Failure with preserved ejection fraction (HFpEF) Heart Failure with preserved ejection fraction (HFpEF) Dr. Pierpaolo Pellicori Hull York Medical School Kingston-upon-Hull United Kingdom Conflict of interest: none Heart failure is a contemporary problem

More information

Transient Atrial Fibrillation and Risk of Stroke after Acute Myocardial Infarction

Transient Atrial Fibrillation and Risk of Stroke after Acute Myocardial Infarction Transient Atrial Fibrillation and Risk of Stroke after Acute Myocardial Infarction Doron Aronson MD, Gregory Telman MD, Fadel BahouthMD, Jonathan Lessick MD, DSc and Rema Bishara MD Department of Cardiology

More information

Ruolo della ablazione della fibrillazione atriale nello scompenso cardiaco

Ruolo della ablazione della fibrillazione atriale nello scompenso cardiaco Ruolo della ablazione della fibrillazione atriale nello scompenso cardiaco Matteo Anselmino Division of Cardiology Città della Salute e della Scienza Hospital University of Turin, Italy Disclosure: Honoraria

More information

A Fresh Look at ARBs : Focus on HF survival data

A Fresh Look at ARBs : Focus on HF survival data A Fresh Look at ARBs : Focus on HF survival data Seok-Min Kang, MD, Ph D. Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea HF specialists ARBs,

More information

Efficacy of beta-blockers in heart failure patients with atrial fibrillation: An individual patient data meta-analysis

Efficacy of beta-blockers in heart failure patients with atrial fibrillation: An individual patient data meta-analysis Efficacy of beta-blockers in heart failure patients with atrial fibrillation: An individual patient data meta-analysis Dipak Kotecha, MD PhD on behalf of the Selection of slides presented at the European

More information

The Role of ICD Therapy in Cardiac Resynchronization

The Role of ICD Therapy in Cardiac Resynchronization The Role of ICD Therapy in Cardiac Resynchronization The Korean Society of Circulation 15 April 2005 Angel R. León, MD Carlyle Fraser Heart Center Division of Cardiology Emory University School of Medicine

More information

Dialysis-Dependent Cardiomyopathy Patients Demonstrate Poor Survival Despite Reverse Remodeling With Cardiac Resynchronization Therapy

Dialysis-Dependent Cardiomyopathy Patients Demonstrate Poor Survival Despite Reverse Remodeling With Cardiac Resynchronization Therapy Dialysis-Dependent Cardiomyopathy Patients Demonstrate Poor Survival Despite Reverse Remodeling With Cardiac Resynchronization Therapy Evan Adelstein, MD, FHRS John Gorcsan III, MD Samir Saba, MD, FHRS

More information

Atrial fibrillation from prevention to treatment

Atrial fibrillation from prevention to treatment State of the Art Atrial fibrillation from prevention to treatment Carina Blomström Lundqvist Dept Cardiology, Uppsala University, Sweden AF - from prevention to treatment 1. Upstream preventive therapy

More information

Drugs acting on the reninangiotensin-aldosterone

Drugs acting on the reninangiotensin-aldosterone Drugs acting on the reninangiotensin-aldosterone system John McMurray Eugene Braunwald Scholar in Cardiovascular Diseases, Brigham and Women s Hospital, Boston & Visiting Professor, Harvard Medical School

More information

RAS Blockade Across the CV Continuum

RAS Blockade Across the CV Continuum A Summary of Recent International Meetings RAS Blockade Across the CV Continuum Copyright New Evidence Presented at the 2009 Congress of the European Society of Cardiology (August 29-September 2, Barcelona)

More information

HFpEF, Mito or Realidad?

HFpEF, Mito or Realidad? HFpEF, Mito or Realidad? Ileana L. Piña, MD, MPH Professor of Medicine and Epidemiology/Population Health Associate Chief for Academic Affairs -- Cardiology Montefiore-Einstein Medical Center Bronx, NY

More information

Devices and Other Non- Pharmacologic Therapy in CHF. Angel R. Leon, MD FACC Division of Cardiology Emory University School of Medicine

Devices and Other Non- Pharmacologic Therapy in CHF. Angel R. Leon, MD FACC Division of Cardiology Emory University School of Medicine Devices and Other Non- Pharmacologic Therapy in CHF Angel R. Leon, MD FACC Division of Cardiology Emory University School of Medicine Disclosure None University of Miami vs. OSU Renegade Miami football

More information

Disclosures for Presenter

Disclosures for Presenter A Comparison of Angiotensin Receptor- Neprilysin Inhibition (ARNI) With ACE Inhibition in the Long-Term Treatment of Chronic Heart Failure With a Reduced Ejection Fraction Milton Packer, John J.V. McMurray,

More information

Prognostic Value of Left Atrial Size and Function

Prognostic Value of Left Atrial Size and Function Prognostic Value of Left Atrial Size and Function James D. Thomas, M.D., F.A.C.C. Cardiovascular Imaging Center Department of Cardiology Cleveland Clinic Foundation Cleveland, Ohio, USA Conflicts: None

More information

HFpEF 2016 : Comorbidities and Outcomes

HFpEF 2016 : Comorbidities and Outcomes HFpEF 2016 : Comorbidities and Outcomes Christopher M. O Connor, MD, FACC CEO and Executive Director, Inova Heart and Vascular Institute Professor of Medicine, Duke University Editor in Chief, JACC: Heart

More information

Dos and Don t in Cardiac Arrhythmia. Case 1 -ECG. Case 1. Management. Emergency Admissions. Reduction of TE risk -CHADS 2 score. Hospital Admissions

Dos and Don t in Cardiac Arrhythmia. Case 1 -ECG. Case 1. Management. Emergency Admissions. Reduction of TE risk -CHADS 2 score. Hospital Admissions Emergency Admissions Dos and Don t in Cardiac Arrhythmia Tom Wong, MD, FESC Consultant Cardiologist, Honorary Senior Lecturer Royal Brompton & Harefield Hospitals National Heart and Lung Institute, Imperial

More information

Cosa c è di nuovo nelle LLGG e nella gestione del paziente con scompenso cardiaco. Maurizio Volterrani IRCCS San Raffaele Rome Capri, 24 April 2015

Cosa c è di nuovo nelle LLGG e nella gestione del paziente con scompenso cardiaco. Maurizio Volterrani IRCCS San Raffaele Rome Capri, 24 April 2015 Cosa c è di nuovo nelle LLGG e nella gestione del paziente con scompenso cardiaco Maurizio Volterrani IRCCS San Raffaele Rome Capri, 24 April 2015 Treatment options for patients with chronic symptomatic

More information

Updates in Heart Failure (HF) 2016: ACC / AHA and ESC

Updates in Heart Failure (HF) 2016: ACC / AHA and ESC Updates in Heart Failure (HF) 2016: ACC / AHA and ESC Patrick McBride, MD, MPH Professor of Medicine & Family Medicine, UW School of Medicine and Public Health Special thanks to: Clyde W. Yancy, MD, MSc

More information

DISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.

DISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics. DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this

More information

Saudi Heart Association February 22, 2011

Saudi Heart Association February 22, 2011 Pharmacological Therapy of Atrial Fibrillation: Recent Advances Dr Martin Green Professor of Medicine (Cardiology) University of Ottawa Saudi Heart Association February 22, 2011 Atrial Fibrillation Drugs

More information

Randomized, double blind, placebo-controlled, for the maintenance of normal sinus rhythm in. FORωARD

Randomized, double blind, placebo-controlled, for the maintenance of normal sinus rhythm in. FORωARD Randomized, double blind, placebo-controlled, independent study to test the efficacy of n-3 3PUFA for the maintenance of normal sinus rhythm in patients with previous atrial fibrillation. FORωARD (Fish

More information

Valsartan Amlodipine HCT Combination: Control To Goal. Dr. Sameh Shaheen M.B.B.Ch, MSc, MD, FESC, FSCAI. Prof of cardiology Ain Shams University

Valsartan Amlodipine HCT Combination: Control To Goal. Dr. Sameh Shaheen M.B.B.Ch, MSc, MD, FESC, FSCAI. Prof of cardiology Ain Shams University Valsartan Amlodipine HCT Combination: Control To Goal Dr. Sameh Shaheen M.B.B.Ch, MSc, MD, FESC, FSCAI Prof of cardiology Ain Shams University Sonesta Hotel Cairo Egypt December 4 th 5 th ; 213 Hypertension

More information

Atrial Fibrillation and Heart Failure: A Cause or a Consequence

Atrial Fibrillation and Heart Failure: A Cause or a Consequence Atrial Fibrillation and Heart Failure: A Cause or a Consequence Rajat Deo, MD, MTR Assistant Professor of Medicine Division of Cardiology, Electrophysiology Section University of Pennsylvania November

More information

RENIN ANGIOTENSIN SYSTEM MODULATION IN CARDIOVASCULAR DISEASE DR. CHARLES KARIUKI INTERVENTIONAL CARDIOLOGIST

RENIN ANGIOTENSIN SYSTEM MODULATION IN CARDIOVASCULAR DISEASE DR. CHARLES KARIUKI INTERVENTIONAL CARDIOLOGIST RENIN ANGIOTENSIN SYSTEM MODULATION IN CARDIOVASCULAR DISEASE DR. CHARLES KARIUKI INTERVENTIONAL CARDIOLOGIST THE CARDIOVASCULAR CONTINUUM Concept proposed in 1991 by Victor Dzau and Eugene Branwald Proposed

More information

ST2 in Heart Failure. ST2 as a Cardiovascular Biomarker. Competitive Model of ST2/IL-33 Signaling. ST2 and IL-33: Cardioprotective

ST2 in Heart Failure. ST2 as a Cardiovascular Biomarker. Competitive Model of ST2/IL-33 Signaling. ST2 and IL-33: Cardioprotective ST2 as a Cardiovascular Biomarker Lori B. Daniels, MD, MAS, FACC Professor of Medicine Director, Coronary Care Unit University of California, San Diego ST2 and IL-33: Cardioprotective ST2: member of the

More information

Effects of Valsartan on Morbidity and Mortality in Patients With Heart Failure Not Receiving Angiotensin-Converting Enzyme Inhibitors

Effects of Valsartan on Morbidity and Mortality in Patients With Heart Failure Not Receiving Angiotensin-Converting Enzyme Inhibitors Journal of the American College of Cardiology Vol. 40, No. 8, 2002 2002 by the American College of Cardiology Foundation ISSN 0735-1097/02/$22.00 Published by Elsevier Science Inc. PII S0735-1097(02)02304-5

More information

State of the art treatment of hypertension: established and new drugs. Prof. M. Burnier Service of Nephrology and Hypertension Lausanne, Switzerland

State of the art treatment of hypertension: established and new drugs. Prof. M. Burnier Service of Nephrology and Hypertension Lausanne, Switzerland State of the art treatment of hypertension: established and new drugs Prof. M. Burnier Service of Nephrology and Hypertension Lausanne, Switzerland First line therapies in hypertension ACE inhibitors AT

More information

Entresto Development of sacubitril/valsartan (LCZ696) for the treatment of heart failure with reduced ejection fraction

Entresto Development of sacubitril/valsartan (LCZ696) for the treatment of heart failure with reduced ejection fraction Cardio-Metabolic Franchise Entresto Development of sacubitril/valsartan (LCZ696) for the treatment of heart failure with reduced ejection fraction Randy L Webb, PhD Rutgers Workshop October 21, 2016 Heart

More information

ECG Underwriting Puzzler. Presented by: William Rooney, M.D.

ECG Underwriting Puzzler. Presented by: William Rooney, M.D. ECG Underwriting Puzzler Presented by: William Rooney, M.D. Obtaining Best Results from this presentation For best results please do the following: Select Slide Show from the menu option on top Select

More information

Catheter Ablation of Atrial Fibrillation Strategy and Outcome Predictors Shih-Ann Chen MD

Catheter Ablation of Atrial Fibrillation Strategy and Outcome Predictors Shih-Ann Chen MD Catheter Ablation of Atrial Fibrillation Strategy and Outcome Predictors Shih-Ann Chen MD Taipei Veterans General Hospital, Taiwan Outline of AF Ablation 1. Strategy for Catheter Ablation of AF 2. Substrate

More information

FA et Apnée du Sommeil

FA et Apnée du Sommeil FA et Apnée du Sommeil La Réunion Octobre 2017 Pascal Defaye CHU Grenoble-Alpes Obstructive Sleep Apnea and AF Incidence of atrial fibrillation (AF), based on presence or absence of OSA. Cumulative frequency

More information

Heart Failure A Disease for the Internist?

Heart Failure A Disease for the Internist? Heart Failure A Disease for the Internist? Dr Chris Davidson Sussex Cardiac Centre BRIGHTON UK Hot Topics in Heart Failure Drug treatments Valsartan / neprilysin inhib Investigations BNP and others Devices

More information

Management of Postoperative Atrial Fibrillation

Management of Postoperative Atrial Fibrillation Management of Postoperative Atrial Fibrillation Stephen D. Cassivi, MD MSc FRCSC FACS Professor of Surgery Vice Chair Department of Surgery cassivi.stephen@mayo.edu Financial Relationship / Conflict of

More information

Arthur J. Moss, MD Professor of Medicine/Cardiology University of Rochester Medical Center Rochester, NY. DISCLOSURE INFORMATION Arthur J.

Arthur J. Moss, MD Professor of Medicine/Cardiology University of Rochester Medical Center Rochester, NY. DISCLOSURE INFORMATION Arthur J. Saving Lives and Preventing Heart Failure: The MADIT Family of Trials Arthur J. Moss, MD Professor of Medicine/Cardiology University of Rochester Medical Center Rochester, NY Update in Electrocardiography

More information

Cardiac Resynchronization Therapy. Michelle Khoo, MD

Cardiac Resynchronization Therapy. Michelle Khoo, MD Cardiac Resynchronization Therapy Michelle Khoo, MD 10.7.08 HuiKuri HV NEJM 2001 Sudden Death (SD) in Subset Populations HuiKuri HV NEJM 2001 Sudden Death (SD) in Subset Populations SD in Competitive Athletes

More information

Atrial Fibrillation Etiologies and Treatment. Shawn Liu Learner Centered Learning Goal

Atrial Fibrillation Etiologies and Treatment. Shawn Liu Learner Centered Learning Goal Atrial Fibrillation Etiologies and Treatment Shawn Liu Learner Centered Learning Goal Pathophysiology Defined by the absence of coordinated atrial systole Results from multiple reentrant electrical waves

More information

Pathophysiology of atrial fibrillation: Insights into the renin angiotensin system

Pathophysiology of atrial fibrillation: Insights into the renin angiotensin system Archives of Cardiovascular Disease (2008) 101, 787 791 CLINICAL RESEARCH Pathophysiology of atrial fibrillation: Insights into the renin angiotensin system Physiopathologie de la fibrillation atriale :

More information

Comorbidities in HF COPD Chronic Obstructive Pulmonary Disease Gerasimos Filippatos Athens, Greece

Comorbidities in HF COPD Chronic Obstructive Pulmonary Disease Gerasimos Filippatos Athens, Greece Comorbidities in HF COPD Chronic Obstructive Pulmonary Disease Gerasimos Filippatos Athens, Greece Epidemiology of heart failure in chronic obstructive pulmonary disease (COPD) patients and vice versa.

More information

Combination of renin-angiotensinaldosterone. how to choose?

Combination of renin-angiotensinaldosterone. how to choose? Combination of renin-angiotensinaldosterone system inhibitors how to choose? Karl Swedberg Professor of Medicine Sahlgrenska Academy University of Gothenburg karl.swedberg@gu.se Disclosures Research grants

More information

Rational Approach to Improving Cardiac Arrhythmia Therapy. Rational Approach to Improving Cardiac Arrhythmia Therapy

Rational Approach to Improving Cardiac Arrhythmia Therapy. Rational Approach to Improving Cardiac Arrhythmia Therapy Rational Approach to Improving Cardiac Arrhythmia Therapy Rational Approach to Improving Cardiac Arrhythmia Therapy Stanley Nattel, MD Stanley Nattel, MD DEDICATED TO THE MASTER OF RATIONAL THERAPEUTICS

More information

Is Heart Rate a Treatment Target?

Is Heart Rate a Treatment Target? Is Heart Rate a Treatment Target? M. Böhm Innere Medizin III (Kardiologie / Angiologie / Internistische Intensivmedizin) Universitätsklinikum des Saarlandes Homburg/Saar michael.boehm@uks.eu Heart Rate

More information

Atrial Fibrillation and Heart Failure

Atrial Fibrillation and Heart Failure Date Clinical Title Atrial Fibrillation and Heart Failure Raul Weiss MD, FAHA, FACC, FHRS and CCDS Director, Electrophysiology Fellowship Program Professor of Medicine The Ohio State University Wexner

More information

Highlight Session Heart failure and cardiomyopathies Michel KOMAJDA Paris France

Highlight Session Heart failure and cardiomyopathies Michel KOMAJDA Paris France Highlight Session 2014 Heart failure and cardiomyopathies Michel KOMAJDA Paris France # esccongress www.escardio.org/esc2014 HEART FAILURE AND CARDIOMYOPATHIES TOPIC 1 Drug Therapy TOPIC 2 Device Therapy

More information

HF-Preserved Ejection Fraction

HF-Preserved Ejection Fraction HF-Preserved Ejection Fraction Justin A. Ezekowitz, MBBCh MSc FRCPC FACC FESC FAHA Associate Professor, University of Alberta Co-Director, Canadian VIGOUR Centre Cardiologist, Mazankowski Alberta Heart

More information

dronedarone, 400mg, film-coated tablets (Multaq ) SMC No. (636/10) Sanofi-aventis Ltd

dronedarone, 400mg, film-coated tablets (Multaq ) SMC No. (636/10) Sanofi-aventis Ltd dronedarone, 400mg, film-coated tablets (Multaq ) SMC No. (636/10) Sanofi-aventis Ltd 6 August 2010 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises

More information

Primary prevention of SCD with the ICD in Nonischemic Cardiomyopathy

Primary prevention of SCD with the ICD in Nonischemic Cardiomyopathy Primary prevention of SCD with the ICD in Nonischemic Cardiomyopathy Michael R Gold, MD, PhD Medical University of South Carolina Charleston, SC USA Disclosures: Consulting and Clinical Trials Medtronic

More information

Diagnosis is it really Heart Failure?

Diagnosis is it really Heart Failure? ESC Congress Munich - 25-29 August 2012 Heart Failure with Preserved Ejection Fraction From Bench to Bedside Diagnosis is it really Heart Failure? Prof. Burkert Pieske Department of Cardiology Med.University

More information

Management of Atrial Fibrillation in Heart Failure

Management of Atrial Fibrillation in Heart Failure Management of Atrial Fibrillation in Heart Failure Hani Sabbour MD FACC FHRS FASE Clinical Assistant Professor of Cardiology Brown University, Warren Alpert School of Medicine Rhode Island, USA Consultant

More information

Sacubitril/Valsartan in HFrEF for All Protagonist View George Honos MD FRCPC FCCS FACC

Sacubitril/Valsartan in HFrEF for All Protagonist View George Honos MD FRCPC FCCS FACC Sacubitril/Valsartan in HFrEF for All Protagonist View George Honos MD FRCPC FCCS FACC Head of Cardiology Medical Manager / CV Program CHUM Disclosure Statement Within the past two years: I have had an

More information

Irbesartan in Patients with Atrial Fibrillation

Irbesartan in Patients with Atrial Fibrillation T h e n e w e ngl a nd j o u r na l o f m e dic i n e original article in Patients with Atrial Fibrillation The ACTIVE I Investigators* A bs tr ac t The members of the writing group (Salim Yusuf, M.B.,

More information

Long-Term Outcome and Risks of Catheter Ablation for Atrial Fibrillation

Long-Term Outcome and Risks of Catheter Ablation for Atrial Fibrillation Long-Term Outcome and Risks of Catheter Ablation for Atrial Fibrillation Carlo Pappone, MD, PhD, FACC EP Director, Villa Maria Hospital Group How many times AF can increase mortality DO MORTALITY REALLY

More information

Atrial Fibrillation: Rate vs. Rhythm. Michael Curley, MD Cardiac Electrophysiology

Atrial Fibrillation: Rate vs. Rhythm. Michael Curley, MD Cardiac Electrophysiology Atrial Fibrillation: Rate vs. Rhythm Michael Curley, MD Cardiac Electrophysiology I have no relevant financial disclosures pertaining to this topic. A Fib Epidemiology #1 Most common heart rhythm disturbance

More information

Left atrial Function In Echocardiography

Left atrial Function In Echocardiography Left atrial Function In Echocardiography Pr Erwan DONAL erwan.donal@chu-rennes.fr Inserm Diastole LA Pressure (mmhg) -t/ 17 LA function 15 A-Loop 13 V-Loop 11 9 7 5 1 2 3 4 20 30 40 50 60 70 LA Volume

More information

Management of chronic heart failure: update J. Parissis Attikon University Hospital

Management of chronic heart failure: update J. Parissis Attikon University Hospital Management of chronic heart failure: update 2015 J. Parissis Attikon University Hospital Disclosures: received honoraria for lectures from Servier, Pfizer, Novartis Discharges in Thousands Heart Failure

More information

From PARADIGM-HF to Clinical Practice. Waleed AlHabeeb, MD, MHA Associate Professor of Medicine President of the Saudi Heart Failure Group

From PARADIGM-HF to Clinical Practice. Waleed AlHabeeb, MD, MHA Associate Professor of Medicine President of the Saudi Heart Failure Group From PARADIGM-HF to Clinical Practice Waleed AlHabeeb, MD, MHA Associate Professor of Medicine President of the Saudi Heart Failure Group PARADIGM-HF: Inclusion Criteria Chronic HF NYHA FC II IV with LVEF

More information

Preventing the cardiovascular complications of hypertension

Preventing the cardiovascular complications of hypertension European Heart Journal Supplements (2004) 6 (Supplement H), H37 H42 Preventing the cardiovascular complications of hypertension Peter Trenkwalder* Department of Internal Medicine, Starnberg Hospital, Ludwig

More information

Vitals HR 90 BP 125/58 Tmax 98.7F O2 Sat 97% on NC 2L/min BMP SCr 1.78 K 3.9 Gluc 194 A1c 7.5 Cardiac LVEF 55% NTproBNP 9,200 Troponin 0.

Vitals HR 90 BP 125/58 Tmax 98.7F O2 Sat 97% on NC 2L/min BMP SCr 1.78 K 3.9 Gluc 194 A1c 7.5 Cardiac LVEF 55% NTproBNP 9,200 Troponin 0. ALDOSTERONE ANTAGONIST IN HEART FAILURE WITH PRESERVED EJECTION FRACTION ABBREVIATIONS BMP: basic metabolic panel HPI: history of present illness CAD: coronary artery disease HR: heart rate PINHUI (JUDY)

More information

Heart Failure: Device Management. Dr Dinesh Pubbi MD FACC Director Electrophysiology

Heart Failure: Device Management. Dr Dinesh Pubbi MD FACC Director Electrophysiology Heart Failure: Device Management Dr Dinesh Pubbi MD FACC Director Electrophysiology Device Therapy in Congestive Heart Failure Outline Definitions and scope of problem Diagnosing and classifying heart

More information

Gerasimos Filippatos MD, FESC, FCCP, FACC

Gerasimos Filippatos MD, FESC, FCCP, FACC Gerasimos Filippatos MD, FESC, FCCP, FACC Head of HF Unit at Athens University Hospital, Greece President (2014-2016) of the HF Association of the European Society of Cardiology (ESC) Served as Chair of

More information

Φαρμακευτική θεραπεία της μετεμφραγματικής καρδιακής ανεπάρκειας. Α. Καραβίδας Υπεύθυνος ιατρείου καρδιακής ανεπάρκειας Γ.Ν.Α Γ.

Φαρμακευτική θεραπεία της μετεμφραγματικής καρδιακής ανεπάρκειας. Α. Καραβίδας Υπεύθυνος ιατρείου καρδιακής ανεπάρκειας Γ.Ν.Α Γ. Φαρμακευτική θεραπεία της μετεμφραγματικής καρδιακής ανεπάρκειας Α. Καραβίδας Υπεύθυνος ιατρείου καρδιακής ανεπάρκειας Γ.Ν.Α Γ.Γεννηματάς Clinical Trials on Fibrinolysis N = 61.41 AMI pts, ( GUSTO I, GUSTOIIb,

More information

The Road to Renin System Optimization: Renin Inhibitor

The Road to Renin System Optimization: Renin Inhibitor The Road to Renin System Optimization: Renin Inhibitor A New Perspective on the Renin-Angiotensin System (RAS) Yong-Jin Kim, MD Seoul National University Hospital Human and Economic Costs of Hypertension

More information

Severe Left Ventricular Dysfunction: Evolving Revascularization Strategies

Severe Left Ventricular Dysfunction: Evolving Revascularization Strategies Severe Left Ventricular Dysfunction: Evolving Revascularization Strategies Robert O. Bonow, MD, MS, MACC Northwestern University Feinberg School of Medicine Bluhm Cardiovascular Institute Northwestern

More information

MMS/Mass Coalition Program, Nov. 4, 2008 Patients with AF: Who Should be on Warfarin?

MMS/Mass Coalition Program, Nov. 4, 2008 Patients with AF: Who Should be on Warfarin? MMS/Mass Coalition Program, Nov. 4, 2008 Patients with AF: Who Should be on Warfarin? Daniel E. Singer, MD Massachusetts General Hospital Harvard Medical School 1 Speaker Disclosure Information DISCLOSURE

More information

Management of ATRIAL FIBRILLATION. in general practice. 22 BPJ Issue 39

Management of ATRIAL FIBRILLATION. in general practice. 22 BPJ Issue 39 Management of ATRIAL FIBRILLATION in general practice 22 BPJ Issue 39 What is atrial fibrillation? Atrial fibrillation (AF) is the most common cardiac arrhythmia encountered in primary care. It is often

More information

Advances in Cardiac Arrhythmias and Great innovations in Cardiology Turin October 2016

Advances in Cardiac Arrhythmias and Great innovations in Cardiology Turin October 2016 University of Brescia School of Medicine Division of cardiologiy Director: Prof Marco Metra, MD, FESC Advances in Cardiac Arrhythmias and Great innovations in Cardiology Turin 13-15 October 2016 Arrhythmias

More information

Heart Failure 101 The Basic Principles of Diagnosis & Management

Heart Failure 101 The Basic Principles of Diagnosis & Management Heart Failure 101 The Basic Principles of Diagnosis & Management Bill Tran, MD Non Invasive Cardiologist February 24, 2018 What the eye does not see and the mind does not know, does not exist. DH Lawrence

More information

THE ROLE OF ICD THERAPY FOR PRIMARY PREVENTION Leonard Ganz, M.D. Pittsburgh, PA

THE ROLE OF ICD THERAPY FOR PRIMARY PREVENTION Leonard Ganz, M.D. Pittsburgh, PA THE ROLE OF ICD THERAPY FOR PRIMARY PREVENTION Leonard Ganz, M.D. Pittsburgh, PA Speakers Bureau: Zoll / Lifecore, Sanofi Aventis, Cardionet Consultant: Boston Scientific, St. Jude Medical, Biotronik,

More information

Beyond neuro-hormonal blockade

Beyond neuro-hormonal blockade Beyond neuro-hormonal blockade Giuseppe M.C. Rosano, MD, PhD, MSc, FESC, FHFA St George s Hospitals NHS Trust University of London KCS Congress: Impact through collaboration CONTACT: Tel. +254 735 833

More information

Disclosures. Advances in Chronic Heart Failure Management 6/12/2017. Van N Selby, MD UCSF Advanced Heart Failure Program June 19, 2017

Disclosures. Advances in Chronic Heart Failure Management 6/12/2017. Van N Selby, MD UCSF Advanced Heart Failure Program June 19, 2017 Advances in Chronic Heart Failure Management Van N Selby, MD UCSF Advanced Heart Failure Program June 19, 2017 I have nothing to disclose Disclosures 1 Goal statement To review recently-approved therapies

More information

Possible clinical and hemodynamic predictors of atrial fibrillation recurrence after catheter ablation

Possible clinical and hemodynamic predictors of atrial fibrillation recurrence after catheter ablation Samara Regional Center of Cardiosurgery Possible clinical and hemodynamic predictors of atrial fibrillation recurrence after catheter ablation S. Dolginina, S. Garkina, S. Khokhlunov, D. Duplyakov Russia

More information

Update in heart failure management. Dr Brian Gordon Consultant Cardiologist

Update in heart failure management. Dr Brian Gordon Consultant Cardiologist Update in heart failure management Dr Brian Gordon Consultant Cardiologist What not to expect Defining/diagnosing heart failure Trial evidence base for heart failure Acute heart failure HF-PEF Advanced

More information

Intravenous Inotropic Support an Overview

Intravenous Inotropic Support an Overview Intravenous Inotropic Support an Overview Shaul Atar, MD Western Galilee Medical Center, Nahariya Affiliated with the Faculty of Medicine of the Galilee, Safed, Israel INOTROPES in Acute HF (not vasopressors)

More information

Outline. Classification by LVEF Conventional Therapy New Therapies. Ivabradine Sacubitril/valsartan

Outline. Classification by LVEF Conventional Therapy New Therapies. Ivabradine Sacubitril/valsartan New Pharmacological Therapies for Heart Failure Mark Drazner, MD, MSc Clinical Chief of Cardiology Medical Director, CHF/VAD/Transplant James M. Wooten Chair in Cardiology UT Southwestern Medical Center

More information

DON T FORGET TO OPTIMISE DEVICE PROGRAMMING

DON T FORGET TO OPTIMISE DEVICE PROGRAMMING CRT:NON-RESPONDERS OR NON-PROGRESSORS? DON T FORGET TO OPTIMISE DEVICE PROGRAMMING Prof. ALİ OTO,MD,FESC,FACC,FHRS Chairman,Department of Cardiology Hacettepe University Faculty of Medicine,Ankara Causes

More information

Feast after Famine: The New Drugs for the Treatment of Heart Failure

Feast after Famine: The New Drugs for the Treatment of Heart Failure Feast after Famine: The New Drugs for the Treatment of Heart Failure Maria Rosa Costanzo, M.D., F.A.C.C., F.A.H.A., F.E.S.C. Medical Director, Advocate Medical Group-Midwest Heart Specialists Heart Failure

More information

Reducing Hospital Readmissions and Increasing Time to Hospital Readmission in Blacks with Heart Failure

Reducing Hospital Readmissions and Increasing Time to Hospital Readmission in Blacks with Heart Failure 10th Annual National Summit on Health Disparities CBC Health Braintrust Meeting April 22 April 23, 2013, Washington, DC Reducing Hospital Readmissions and Increasing Time to Hospital Readmission in Blacks

More information

Heart Failure with Preserved EF (HFPEF) Epidemiology and management

Heart Failure with Preserved EF (HFPEF) Epidemiology and management Heart Failure with Preserved EF (HFPEF) Epidemiology and management Karl Swedberg Senior Professor of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg, Sweden e-mail: karl.swedberg@gu.se

More information

Chapter 9. Learning Objectives. Learning Objectives 9/11/2012. Cardiac Arrhythmias. Define electrical therapy

Chapter 9. Learning Objectives. Learning Objectives 9/11/2012. Cardiac Arrhythmias. Define electrical therapy Chapter 9 Cardiac Arrhythmias Learning Objectives Define electrical therapy Explain why electrical therapy is preferred initial therapy over drug administration for cardiac arrest and some arrhythmias

More information

LEFT BUNDLE BRANCH BLOCK- BENIGN OR A HARBINGER OF HEART FAILURE? PROGNOSTIC INDICATOR?

LEFT BUNDLE BRANCH BLOCK- BENIGN OR A HARBINGER OF HEART FAILURE? PROGNOSTIC INDICATOR? LEFT BUNDLE BRANCH BLOCK- BENIGN OR A HARBINGER OF HEART FAILURE? PROGNOSTIC INDICATOR? Juan Cinca Department and Chair of Cardiology Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona

More information

Heart Failure New Drugs- Updated Guidelines

Heart Failure New Drugs- Updated Guidelines Heart Failure New Drugs- Updated Guidelines Eileen Handberg, PhD, ANP-BC, FAHA, FACC Professor of Medicine Division of Cardiovascular Medicine University of Florida Disclosures 1. 3 2. 6 3. 8 4. 11 Dunlay

More information

Update on Dronedarone and Cardiovascular Outcomes

Update on Dronedarone and Cardiovascular Outcomes Update on and Cardiovascular Outcomes Dr. Stuart Connolly MD McMaster University Hamilton Ontario Disclosure: Research grants, speaker fees and consulting honoraria from sanofi aventis has key structural

More information

Saudi Arabia February Pr Michel KOMAJDA. Université Pierre et Marie Curie Hospital Pitié Salpétrière

Saudi Arabia February Pr Michel KOMAJDA. Université Pierre et Marie Curie Hospital Pitié Salpétrière Prevention of Cardiovascular events with Ivabradine: The SHIFT Study Saudi Arabia February 2011 Pr Michel KOMAJDA Université Pierre et Marie Curie Hospital Pitié Salpétrière Paris FRANCE Declaration Of

More information

Targeting the late sodium channel: A new antiarrhythmic paradigm?

Targeting the late sodium channel: A new antiarrhythmic paradigm? Targeting the late sodium channel: A new antiarrhythmic paradigm? Wojciech Zareba, MD, PhD Professor of Medicine/Cardiology University of Rochester Medical Center Rochester, NY Disclosures: - Gilead Sciences:

More information

Omega-3 Fatty Acids for Prevention of Post-Operative Atrial Fibrillation

Omega-3 Fatty Acids for Prevention of Post-Operative Atrial Fibrillation Omega-3 Fatty Acids for Prevention of Post-Operative Atrial Fibrillation Roberto Marchioli, MD, on behalf of the OPERA Investigators American Heart Association, Los Angeles November 5, 2012 Published online

More information

Prevention of Atrial Fibrillation by Renin-Angiotensin System Inhibition

Prevention of Atrial Fibrillation by Renin-Angiotensin System Inhibition Journal of the American College of Cardiology Vol. 55, No. 21, 2010 2010 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2010.01.043

More information

Moderate Aortic Stenosis and Heart Failure

Moderate Aortic Stenosis and Heart Failure Moderate Aortic Stenosis and Heart Failure Nicolas M. Van Mieghem, MD, PhD, FACC, FESC Director of Interventional Cardiology Thoraxcenter, Erasmus MC Rotterdam TAVI Market Projections for 2025 Expected

More information

Hypertension Management in Diabetic Patients

Hypertension Management in Diabetic Patients Hypertension Management in Diabetic Patients Park, Chang G, MD, PhD Cardiovascular Center, Guro Hospital, Korea University Medical School Contents (Treatment of 2 Cases) Type 2 Diabetes Mellitus Hypertension

More information

It has been shown from meta-analysis of randomized clinical trials that patients with a pre-crt QRS duration (QRSD) >150 ms benefit

It has been shown from meta-analysis of randomized clinical trials that patients with a pre-crt QRS duration (QRSD) >150 ms benefit Cardiac Resynchronization Therapy may be detrimental in patients with a Very Wide QRSD > 180 ms (VWQRSD) and Right Bundle Branch Block Morphology: Analysis From the Medicare ICD Registry Varun Sundaram

More information