Antiarrhythmic drug therapy for the prevention of atrial fibrillation recurrences
|
|
- Meryl Shelton
- 5 years ago
- Views:
Transcription
1 2012 Update of the ESC Guidelines on the Management of Atrial Fibrillation Antiarrhythmic drug therapy for the prevention of atrial fibrillation recurrences Stefan H. Hohnloser J.W. Goethe University Frankfurt am Main S.H.H. has served as a consultant, member of the steering committee, or speaker for: Bayer Healthcare, BMS, Boehringer Ingelheim, Boston Scientific, Cardiome, Forest RI, J&J, Medtronic, Pfizer, Portola, Sanofi aventis, St. Jude Medical
2 European Heart Journal doi: /eurheartj/ehs focused update of the ESC Guidelines for the Management of Atrial Fibrillation An update of the 2010 ESC Guidelines for the Management of Atrial Fibrillation Developed with the special contribution of the European Heart Rhythm Association Authors/Task Force Members: A. John Camm (Chairperson) (UK)*, Gregory Y. H. Lip (UK), Dan Atar (Norway), Raffaele De Caterina (Italy), Gerhard Hindricks (Germany), Stefan H. Hohnloser (Germany), Paulus Kirchhof (Germany/UK), Irene Savelieva (UK) ESC Committee for Practice Guidelines (CPG): Jeroen J. Bax (CPG Chairperson) (The Netherlands), Helmut Baumgartner (Germany), Claudio Ceconi (Italy), Veronica Dean (France), Christi Deaton (UK), Robert Fagard (Belgium), Christian Funck-Brentano (France), David Hasdai (Israel), Arno Hoes (The Netherlands), Paulus Kirchhof (Germany/UK), Juhani Knuuti (Finland), Philippe Kolh (Belgium), Theresa McDonagh (UK), Cyril Moulin (France), Bogdan A. Popescu (Romania), Željko Reiner (Croatia), Udo Sechtem (Germany), Per Anton Sirnes (Norway), Michal Tendera (Poland), Adam Torbicki (Poland), Alec Vahanian (France),Stephan Windecker (Switzerland). Document Reviewers: Panos Vardas (Review Coordinator) (Greece), Nawwar Al-Attar (France), Ottavio Alfieri (Italy), Annalisa Angelini (Italy), Carina Blömstrom-Lundqvist (Sweden), Paolo Colonna (Italy), Johan De Sutter (Belgium), Sabine Ernst (UK), Andreas Goette (Germany), Bulent Gorenek (Turkey), Robert Hatala (Slovak Republic), Hein Heidbüchel (Belgium), Magnus Heldal (Norway), Steen Dalby Kristensen (Denmark), Philippe Kolh (Belgium), Jean-Yves Le Heuzey (France), Hercules Mavrakis (Greece), Lluís Mont (Spain), Pasquale Perrone Filardi (Italy), Piotr Ponikowski (Poland), Bernard Prendergast (UK), Frans Rutten (The Netherlands), Ulrich Schotten (The Netherlands), Isabelle C. Van Gelder (The Netherlands), Freek Verheugt (The Netherlands) European Heart Journal doi: /eurheartj/ehs253
3 Principles of antiarrhythmic drug therapy to maintain sinus rhythm 1. Treatment is motivated by attempts to reduce AF-related symptoms. 2. Efficacy of antiarrhythmic drugs to maintain sinus rhythm is modest. 3. Clinically successful antiarrhythmic drug therapy may reduce rather than eliminate recurrence of AF. 4. If one antiarrhythmic drug fails a clinically acceptable response may be achieved with another agent. 5. Drug-induced proarrhythmia or extra-cardiac side-effects are frequent. 6. Safety rather than efficacy considerations should primarily guide the choice of antiarrhythmic agent. European Heart Journal (2010) 31,
4 Suggested doses and main caveats for commonly used antiarrhythmic drugs Drug Dose Main contraindications and precautions ECG monitoring AV nodal slowing Disopyramide Flecainide mg t.i.d mg b.i.d. Contraindicated in systolic heart failure, SND, and AVB II and III without PM. Caution when using concomitant medication with QT-prolonging drugs. Contraindicated if creatinine clearance < 50 mg/ml, in coronary artery disease, reduced LV ejection fraction, heart failure. Flecanide XL 200 mg o.d. Caution in the presence of conduction system disease. Propafenone mg t.i.d. Contraindicated in coronary artery disease, heart failure. QT interval QRS duration increase > 25% above baseline QRS duration increase > 25% above baseline None None Slight Propafenone SR mg b.i.d. Caution in the presence of conduction system disease and renal impairment. Changes from 2010 Guidelines AF = atrial fibrillation; AV = atrioventricular; bpm = beats per minute; CYP = cytochrome P; ECG = electrocardiogram; LV = left ventricular; NYHA = New York Heart Association. European Heart Journal doi: /eurheartj/ehs253
5 Suggested doses and main caveats for commonly used antiarrhythmic drugs Drug Dose Main contraindications and precautions d,l-sotalol Amiodarone mg b.i.d mg o.d. for 4 weeks, 400 mg o.d. for 4 weeks then 200 mg o.d. Contraindicated in the presence of significant LV hypertrophy, systolic heart failure, pre-existing QT prolongation, hypokalaemia, significant renal impairment Creatinine clearance < 50 mg/ml. Moderate renal dysfunction requires careful adaptation of dose. Caution when using concomitant medication with QT-prolonging drugs, heart failure. Dose of vitamin K antagonists and of digitoxin/digoxin should be reduced. Creatinine, liver enzymes, thyroid hormones, & lung function should be monitored Changes from 2010 Guidelines ECG features prompting lower dose or discontinuation QT interval > 500 ms QT interval >500 ms AV nodal slowing Similar to high-dose β-blockers bpm in AF AF = atrial fibrillation; AV = atrioventricular; bpm = beats per minute; CYP = cytochrome P; ECG = electrocardiogram; LV = left ventricular; NYHA = New York Heart Association. European Heart Journal doi: /eurheartj/ehs253
6 Suggested doses and main caveats for commonly used antiarrhythmic drugs Drug Dose Main contraindications and precautions 400 mg b.i.d. Contraindicated in NYHA class III IV or unstable heart failure, during concomitant medication with QTprolonging drugs, powerful CYP 3A4 inhibitors, if creatinine clearance < 30 mg/ml. Not advised in other forms of heart failure, unless no appropriate alternative. Cautious use in CHD. Regular monitoring of liver function. Dose of digitoxin/digoxin should be reduced. Elevations in serum creatinine of mg/dl are common and do not reflect reduced renal function. ECG features prompting lowerdose or discontinuation QT interval > 500 ms AV nodal slowing bpm in AF Changes from 2010 Guidelines AF = atrial fibrillation; AV = atrioventricular; bpm = beats per minute; CYP = cytochrome P; ECG = electrocardiogram; LV = left ventricular; NYHA = New York Heart Association. European Heart Journal doi: /eurheartj/ehs253
7 Choice of antiarrhythmic for the patient with no or minimal structural heart disease No or minimal structural heart disease Adrenergically mediated Undetermined Vagally mediated β-blockers Flecainide Propafenone Sotalol Disopyramide Sotalol Amiodarone European Heart Journal (2010) 31,
8 Choice of antiarrhythmic for the patient with no or minimal structural heart disease No or minimal structural heart disease Adrenergically mediated Undetermined Vagally mediated β-blockers Flecainide Propafenone Sotalol Disopyramide Sotalol Amiodarone European Heart Journal (2010) 31,
9 Choice of antiarrhythmic drug according to underlying pathology Minimal or no heart disease Significant underlying heart disease? Prevention of remodeling ACE/ARB/statin β-blockade where appropriate Treatment of underlying condition and? Prevention/reversal of remodelling - ACEI/ARB/statin. β-blockade where appropriate HT CAD CHF No LVH LVH Stable NYHA I/II NYHA III/IV or unstable NHYA II / Flecainide / Propafenone / Sotalol Sotalol Amiodarone Amiodarone Amiodarone ACEI = angiotensin-converting enzyme inhibitor; ARB = angiotensin receptor blocker; CAD = coronary artery disease; CHF = congestive heart failure; HT = hypertension; LVH = left ventricular hypertrophy; NYHA = New York Heart Association; unstable = cardiac decompensation within the prior 4 weeks. Antiarrhythmic agents are listed in alphabetical order within each treatment box.? = evidence for upstream therapy for prevention of atrial remodelling still remains controversial. European Heart Journal (2010) 31,
10 ACE-I = angiotensin converting enzyme inhibitor; ARB = angiotensin II receptor blocker; CHD = coronary heart disease; CHF = congestive heart failure; HHD = hypertensive heart disease; LVH = left ventricular hypertrophy. Antiarrhythmic drug management of non-permanent AF Minimal or no structural heart disease Significant structural heart disease Treatment of underlying condition and prevention of remodelling ACE-I / ARB / statins HHD CHD CHF No LVH LVH sotalol dronedarone / flecainide / propafenone / sotalol dronedarone dronedarone amiodarone amiodarone amiodarone European Heart Journal doi: /eurheartj/ehs253
11 Choice of an antiarrhythmic drug for AF control (I) Recommendations Class a Level b The following antiarrhythmic drugs are recommended for rhythm control in patients with AF, depending on underlying heart disease: amiodarone I A dronedarone I A flecainide I A propafenone I A d,i-sotalol I A Amiodarone is more effective in maintaining sinus rhythm than sotalol, propafenone, flecainide (by analogy) or dronedarone (LoE A), but because of its toxicity profile should generally be used when other agents have failed or are contraindicated (LoE C). In patients with heart failure amiodarone should be the drug of choice. I B is recommended in patients with recurrent AF as a moderately effective antiarrhythmic agent for the maintenance of sinus rhythm. In patients without significant structural heart disease, initial antiarrhythmic therapy should be chosen from dronedarone, flecainide, propafenone, and sotalol. I I I A C A A European Heart Journal doi: /eurheartj/ehs253
12 Cumulative incidence Cumulative incidence EURIDIS & ADONIS: Primary Endpoint 1,237 patients (409 randomized to placebo, 828 to dronedarone) EURIDIS HR = 0.78 ( ) P = Time (days) Time (days) Placebo 400 mg BID ADONIS HR = 0.73 ( ) P = Singh BN, et al. N Engl J Med. 2007;357:
13 Cumulative incidence (%) ATHENA: Morbidity/Mortality Study in 4,628 Patients with AF Cummulative Incidence (%) 1 0 Outcome: Time to First Cardiovascular Hospitalization or Death HR = 0.76 HR=0.76 P P<0.001 < Patients at risk Months Patients Placebo at risk: Placebo , , ,625 1, ,301 1,963 1,776 1, Placebo Months Hohnloser SH, et al. N Engl J Med. 2009;360:
14 Choice of an antiarrhythmic drug for AF control (II) Recommendations Class a Level b If one antiarrhythmic drug fails to reduce the recurrence of AF to a clinically acceptable level, the use of another antiarrhythmic drug should be considered. should be considered in order to reduce cardiovascular hospitalizations in patients with non-permanent AF and cardiovascular risk factors. ß-blockers should be considered for rhythm (plus rate) control in patients with a first episode of AF. Short-term (4 weeks) antiarrhythmic therapy after cardioversion may be considered in selected patients e.g., those at risk for therapy-associated complications. IIa IIa IIa IIb C B C B a Class of recommendation. b Level of evidence. AF = atrial fibrillation; LoE = level of evidence. European Heart Journal doi: /eurheartj/ehs253
15 Survival probability Short- vs long-term AAD Rx after cardioversion 635 patients, mean age 64 years, flecainide 4 weeks vs long-term therapy Primary outcome: time to persistent AF or death, monitored by telemetric ECG Time to event (days) Kirchhof et al, Published online June 18, 2012 DOI: /S (12)
16 Survival probability Kirchhof et al, Published online June 18, 2012 DOI: /S (12) Short- vs long-term AAD Rx after cardioversion Landmark analysis after 1 month Timefrom 1 month to event (days) Short-term AAD Rx after cardioversion prevents approximately 80% of AF recurrences, although long-term therapy is statistically more effective.
17 Choice of an antiarrhythmic drug for AF control (III) Recommendations Class a Level b is not recommended for treatment of AF in patients with NYHA class III and IV, or with recently unstable (decompensation within the prior month) NYHA class II heart failure. III B is not recommended in patients with permanent AF III B Antiarrhythmic drug therapy is not recommended for maintenance of sinus rhythm in patients with advanced sinus node disease or AV node dysfunction unless they have a functioning permanent pacemaker. III C a Class of recommendation. b Level of evidence. AF = atrial fibrillation; LoE = level of evidence. European Heart Journal doi: /eurheartj/ehs253
18 Cumulative Hazard PALLAS: First co-primary outcome (stroke, MI, SEE, CV death) Median follow-up 3.5 months HR 2.29 ( ; p = 0.002) Placebo Months No. at Risk Placebo N Engl J Med 2011;365:
19 Cumulative Hazard PALLAS: Second co-primary outcome (unplanned CV hospitalization or death) Placebo Median follow-up 3.5 months HR 1.95 ( ; p < 0.001) Months No. at Risk Placebo N Engl J Med 2011;365:
20 Summary of Recommendations Regarding the Use of Recommendations Class a Level b is recommended in patients with recurrent AF as a moderately effective antiarrhythmic agent for the maintenance of sinus rhythm. should be considered in order to reduce cardiovascular hospitalizations in patients with non-permanent AF and cardiovascular risk factors. is not recommended for treatment of AF in patients with NYHA class III and IV, or with recently unstable (decompensation within the prior month) NYHA class II heart failure. I IIa III A B B is not recommended in patients with permanent AF III B a Class of recommendation. b Level of evidence. AF = atrial fibrillation; LoE = level of evidence. European Heart Journal doi: /eurheartj/ehs253
21 Choice between ablation and antiarrhythmic drug therapy for patients with and without structural heart disease Relevant underlying heart disease No or minimal heart disease (including HT without LVH) CHF CAD Hypertension with LVH Paroxysmal AF Persistent AF NYHA III/IV or unstable NHYA II Stable NYHA III Sotalol Catheter ablation for AF * Flecainide Propafenone Sotalol Amiodarone Catheter ablation for AF Amiodarone More extensive LA ablation may be needed; *usually PVI is appropriate. AF = atrial fibrillation; CAD = coronary artery disease; CHF = congestive heart failure; HT = hypertension; LVH = left ventricular hypertrophy; NYHA = New York Heart Association; PVI = pulmonary vein isolation. Antiarrhythmic agents are listed in alphabetical order within each treatment box. European Heart Journal (2010) 31,
22 Antiarrhythmic drugs and/or left atrial ablation for rhythm control in AF No or minimal structural heart disease Relevant structural heart disease Yes HF No Paroxysmal Persistent Patient choice Yes Due to AF No * Catheter ablation dronedarone, flecainide, propafenone, sotalol Patient choice amiodarone Patient choice Catheter ablation dronedaroneǂ, sotalol * * = usually PVI is appropriate = more extensive LA ablation may be needed; * = not recommended in LVH; ǂ caution with coronary heart disease; HF = heart failure. amiodarone European Heart Journal doi: /eurheartj/ehs253
23 European Heart Journal doi: /eurheartj/ehs focused update of the ESC Guidelines for the Management of Atrial Fibrillation An update of the 2010 ESC Guidelines for the Management of Atrial Fibrillation Developed with the special contribution of the European Heart Rhythm Association Authors/Task Force Members: A. John Camm (Chairperson) (UK)*, Gregory Y. H. Lip (UK), Dan Atar (Norway), Raffaele De Caterina (Italy), Gerhard Hindricks (Germany), Stefan H. Hohnloser (Germany), Paulus Kirchhof (Germany/UK), Irene Savelieva (UK) ESC Committee for Practice Guidelines (CPG): Jeroen J. Bax (CPG Chairperson) (The Netherlands), Helmut Baumgartner (Germany), Claudio Ceconi (Italy), Veronica Dean (France), Christi Deaton (UK), Robert Fagard (Belgium), Christian Funck-Brentano (France), David Hasdai (Israel), Arno Hoes (The Netherlands), Paulus Kirchhof (Germany/UK), Juhani Knuuti (Finland), Philippe Kolh (Belgium), Theresa McDonagh (UK), Cyril Moulin (France), Bogdan A. Popescu (Romania), Željko Reiner (Croatia), Udo Sechtem (Germany), Per Anton Sirnes (Norway), Michal Tendera (Poland), Adam Torbicki (Poland), Alec Vahanian (France),Stephan Windecker (Switzerland). Document Reviewers: Panos Vardas (Review Coordinator) (Greece), Nawwar Al-Attar (France), Ottavio Alfieri (Italy), Annalisa Angelini (Italy), Carina Blömstrom-Lundqvist (Sweden), Paolo Colonna (Italy), Johan De Sutter (Belgium), Sabine Ernst (UK), Andreas Goette (Germany), Bulent Gorenek (Turkey), Robert Hatala (Slovak Republic), Hein Heidbüchel (Belgium), Magnus Heldal (Norway), Steen Dalby Kristensen (Denmark), Philippe Kolh (Belgium), Jean-Yves Le Heuzey (France), Hercules Mavrakis (Greece), Lluís Mont (Spain), Pasquale Perrone Filardi (Italy), Piotr Ponikowski (Poland), Bernard Prendergast (UK), Frans Rutten (The Netherlands), Ulrich Schotten (The Netherlands), Isabelle C. Van Gelder (The Netherlands), Freek Verheugt (The Netherlands) European Heart Journal doi: /eurheartj/ehs253
What s New in the AF Guidelines
Impact on New AF Guidelines on Heart Failure Management Gothenburg - May 22 nd 2011 Europace (2010) 12, 1360-420 http://europace.oxfordjournals.org JACC (2011) 57, 223-42 http://www.cardiosource.org What
More informationTreatment of Atrial Fibrillation in Heart Failure
Stockholm, September 1st 2010 Treatment of Atrial Fibrillation in Heart Failure Rhythm control: Which drugs? Stefan H. Hohnloser J.W. Goethe University Frankfurt, Germany Presenter disclosure information:
More informationESC / EACTS Guidelines for the Management of Valvular Heart Disease. Management of Aortic Regurgitation
ESC / EACTS Guidelines for the Management of Valvular Heart Disease Management of Aortic Regurgitation Hans-Joachim Schäfers Saarland University Medical Center, Homburg/Saar, Germany On behalf of the ESC/EACTS
More informationDebate PRO. Dronedarone is an important drug in the management of paroxysmal atrial fibrillation. John Camm
ESC ICM - Internationales Congress Center München 2012 Atrial Fibrillation Controversies in Medical Treatment Debate Dronedarone is an important drug in the management of paroxysmal atrial fibrillation
More informationDevice therapy in heartfailure Update of the ESC guidelines. Karl Swedberg
Device therapy in heartfailure Update of the ESC guidelines Karl Swedberg Professor of Medicine Department of emergency and cardiovascular medicine Sahlgrenska Academy University of Gothenburg, Sweden
More information» A new drug s trial
» A new drug s trial A placebo-controlled, double-blind, parallel arm Trial to assess the efficacy of dronedarone 400 mg bid for the prevention of cardiovascular Hospitalization or death from any cause
More informationDIU Rythmologie / Stimulation, 29 Janvier 2014!
FIBRILLATION ATRIALE : STRATEGIE ANTIARYTHMIQUE, CARDIOVERSION (PHARMACOLOGIQUE ET ELECTRIQUE)! J.Y. LE HEUZEY! Hopital Georges Pompidou! Université René Descartes, Paris! DIU Rythmologie / Stimulation,
More informationPolypharmacy - arrhythmic risks in patients with heart failure
Influencing sudden cardiac death by pharmacotherapy Polypharmacy - arrhythmic risks in patients with heart failure Professor Dan Atar Head, Dept. of Cardiology Oslo University Hospital Ullevål Norway 27.8.2012
More informationMedical management of AF: drugs for rate and rhythm control
Medical management of AF: drugs for rate and rhythm control Adel Khalifa Sultan Hamad, BMS, MD, FGHRS, FRCP(Canada) Consultant Cardiologist & Interventional Cardiac Electrophysiologist Head of Electrophysiology
More informationAF#in#pa(ents#with#CAD# Is#dronedarone#a#good#choice?!
AF#in#pa(ents#with#CAD# Is#dronedarone#a#good#choice?! DRUG#PROPHYLAXIS#OF#AF:# FOCUS#ON#DRONEDARONE# Friday#16C10C2015# Harry%JGM%Crijns% Maastricht,%The%Netherlands% Disclosures Harry Crijns - research
More informationReviews. Benefit-Risk Assessment of Current Antiarrhythmic Drug Therapy of Atrial Fibrillation
Reviews Benefit-Risk Assessment of Current Antiarrhythmic Drug Therapy of Atrial Fibrillation Address for correspondence: Stefan H. Hohnloser, MD Department of Cardiology J.W. Goethe University Hospital
More informationDronedarone: Need to Perform a CV Outcome Safety Study
Dronedarone: Need to Perform a CV Outcome Safety Study Gerald V. Naccarelli M.D. Consultant: Glaxo-Smith-Kline, Pfizer, Sanofi, Boehringer-Ingelheim, Daiichi-Sankyo, Bristol Myers Squibb, Otsuka, Janssen
More informationRate and Rhythm Control of Atrial Fibrillation
Rate and Rhythm Control of Atrial Fibrillation April 21, 2017 춘계심혈관통합학술대회 Jaemin Shim, MD, PhD Arrhythmia Center Korea University Anam Hospital Treatment of AF Goal Reducing symptoms Preventing complication
More informationESC Congress 2012, Munich
ESC Congress 2012, Munich Anticoagulation in Atrial Fibrillation 2012: Which Anticoagulant for Which Patient? Stefan H. Hohnloser J.W. Goethe University Frankfurt am Main S.H.H. has served as a consultant,
More informationPercutaneous Mitral Valve Repair. Khalil Fattouch, MD, PhD
Percutaneous Mitral Valve Repair Khalil Fattouch, MD, PhD J Thorac Cardiovasc Surg 1983;86:323-37 Euro Heart Survey Results:One-year survival Operated (222 pts) 96.3± 1.3% Non-operated (174 pts) 88.2±
More informationThe RealiseAF registry:
The RealiseAF registry: An International, observational, cross-sectional survey evaluating atrial fibrillation management and the cardiovascular risk profile of AF patients initial results PG.Steg on behalf
More informationDronedarone in the Post-Pallas Era. Jorge E. Schliamser, MD Carmel Medical Center Haifa
Dronedarone in the Post-Pallas Era Jorge E. Schliamser, MD Carmel Medical Center Haifa Disclosures None Dronedarone is a multichannel blocker Dronedarone possesses electrophysiologic characteristics of
More informationdronedarone, 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 informationSaudi 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 informationAntiarrhythmic agents in 2014
7 AP-HRS Scientific Session, New Dehli, India - Oct 29 to Nov 1, 2014 Antiarrhythmic agents in 2014 Antonio Raviele, MD, FESC, FHRS President ALFA Alliance to Fight Atrial fibrillation - Venice, Italy
More informationScreening for atrial fibrillation with the WatchBP device as compared to current clinical practice: a cost-analysis.
Screening for atrial fibrillation with the WatchBP device as compared to current clinical practice: a cost-analysis. Introduction Atrial Fibrillation Atrial fibrillation (AF) is the most common cardiac
More informationPALLAS. Dronedarone on Top of Standard Therapy. Stuart J. Connolly MD. on behalf of the PALLAS investigators
PALLAS Permanent Atrial FibriLLAtion Outcome Study using on Top of Standard Therapy Stuart J. Connolly MD on behalf of the PALLAS investigators http://clinicaltrials.gov Number: NCT01151137 1 Disclosure
More informationUpdate 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 informationCost and Prevalence of A fib. Atrial Fibrillation: Guideline Directed Treatment. Prevalence of A Fib. Risk Factors for A Fib. Risk Factors for A Fib
Atrial Fibrillation: Guideline Directed Treatment Melissa Wendell, FNP-C, MSN Heart Failure - Lead Nurse Practitioner, Aspirus Wausau Hospital and Aspirus Cardiology Cost and Prevalence of A fib 33.5 million
More informationWho Gets Atrial Fibrilla9on..?
Birmingham October 20 th 2013 AFA Pa9ents Day Symptoma9c Atrial Fibrilla9on What therapies are available? GENERAL BACKGROUND Andrew Grace Papworth Hospital and University of Cambridge Consultant: Medtronic
More informationATRIAL FIBRILLATION: REVISITING CONTROVERSIES IN AN ERA OF INNOVATION
ATRIAL FIBRILLATION: REVISITING CONTROVERSIES IN AN ERA OF INNOVATION Frederick Schaller, DO, MACOI,FACP Adjunct Clinical Professor Touro University Nevada DISCLOSURES I have no financial relationships
More informationIntroduction. CLINICAL RESEARCH Atrial fibrillation
European Heart Journal (2014) 35, 1856 1863 doi:10.1093/eurheartj/ehu048 CLINICAL RESEARCH Atrial fibrillation Efficacy and safety of apixaban compared with aspirin in patients who previously tried but
More informationSaudi 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 informationESC Stockholm Arrhythmias & pacing
ESC Stockholm 2010 Take Home Messages for Practitioners Arrhythmias & pacing Prof. Panos E. Vardas Professor of Cardiology Heraklion University Hospital Crete, Greece Disclosures Small teaching fees from
More informationESC. Update of the ESC Guidelines on Medical Therapy. John Camm. ICM Internationales Congress Center München
ESC 2012 ICM Internationales Congress Center München Update on Consensus Statements on Management of Atrial Fibrillation European Heart Rhythm Association Update of the ESC Guidelines on Medical Therapy
More informationDronedarone( What%is%the%future?!
Dronedarone( What%is%the%future?! DRUG(PROPHYLAXIS(OF(AF:( FOCUS(ON(DRONEDARONE( Friday(16>10>2015( Harry%JGM%Crijns% Maastricht,%The%Netherlands% Disclosures Harry Crijns - research grants, consulting
More information2012 focused update of the ESC Guidelines for the management of atrial fibrillation
European Heart Journal (2012) 33, 2719 2747 doi:10.1093/eurheartj/ehs253 ESC GUIDELINES 2012 focused update of the ESC Guidelines for the management of atrial fibrillation An update of the 2010 ESC Guidelines
More informationGeriatric Grand Rounds
Geriatric Grand Rounds Tuesday, April 13, 21 12: noon Dr. Bill Black Auditorium Glenrose Rehabilitation Hospital In keeping with Glenrose Rehabilitation Hospital policy, speakers participating in this
More informationPRESCRIBING ALERT
www.empr.com PRESCRIBING ALERT Dear Healthcare Professional, At MPR we strive to bring you important drug information in a concise and timely fashion. In keeping with this goal, we are pleased to bring
More informationDronedarone For Atrial Fibrillation: Unbridled Enthusiasm Or Just Another Small Step Forward?
Dronedarone For Atrial Fibrillation: Unbridled Enthusiasm Or Just Another Small Step Forward? James A. Reiffel, M.D. Introduction In July 2009, the federal Food and Drug Administration (FDA) approved the
More informationUse of Antiarrhythmic Drugs for AF Who, What and How? Dr. Marc Cheng Queen Elizabeth Hospital
Use of Antiarrhythmic Drugs for AF Who, What and How? Dr. Marc Cheng Queen Elizabeth Hospital Content i. Rhythm versus Rate control ii. Anti-arrhythmic for Rhythm Control iii. Anti-arrhythmic for Rate
More informationSamer Nasr, M.D. Mount Lebanon Hospital.
Samer Nasr, M.D. Mount Lebanon Hospital. Lone atrial fibrillation: Younger than 60 years old. No clinical or echo evidence of cardiopulmonary disease. Favorable prognosis. Thromboembolism usually not
More information2012 focussed update of the ESC Guidelines for the Management of Atrial Fibrillation
European Heart Journal 2012 doi:10.1093/eurheartj/ehs253 ESC 2012 2012 focussed update of the ESC Guidelines for the Management of Atrial Fibrillation An update of the 2010 ESC Guidelines for the Management
More informationEHRA Position Documents on new technology or standards of care
EHRA Position Documents on new technology or standards of care Prof. Laurent Fauchier Cardiologie, Centre Hospitalier Universitaire Trousseau Tours, France Disclosures Laurent Fauchier: Lecture fees: Bayer,
More informationAtrial Fibrillation 2009
Atrial Fibrillation 2009 Michael Glikson, MD Director of Pacing & Electrophysiology Leviev Heart Center Sheba medical Center Sheba Medical Center Tel Hashomer The Leviev Heart Center Rhythm vs rate control
More informationUnderstanding Atrial Fibrillation Management. Roy Lin, MD
Understanding Atrial Fibrillation Management Roy Lin, MD Disclosure None Definition of atrial fibrillation Atrial fibrillation is a supraventricular tachyarrhythmia characterized by uncoordinated atrial
More informationDronedarone for the treatment of non-permanent atrial fibrillation
Dronedarone for the treatment of non-permanent atrial Issued: August 2010 last modified: December 2012 guidance.nice.org.uk/ta197 NICE has accredited the process used by the Centre for Health Technology
More informationAre Drugs Better? Dr Mauro Lencioni. Drugs or ablation as first line treatment for AF? Consultant Cardiologist & Electrophysiologist
Are Drugs Better? Drugs or ablation as first line treatment for AF? Dr Mauro Lencioni Consultant Cardiologist & Electrophysiologist The Philosophical Issue What do we mean by Better? Outcome measures Measurement
More informationNational Horizon Scanning Centre. Dronedarone (Multaq) for atrial fibrillation and atrial flutter. December 2007
Dronedarone (Multaq) for atrial fibrillation and atrial flutter December 2007 This technology summary is based on information available at the time of research and a limited literature search. It is not
More informationLa patologia valvolare dell anziano: problemi decisionali complessi. Ottavio Alfieri S.Raffaele University Hospital Milan
La patologia valvolare dell anziano: problemi decisionali complessi Ottavio Alfieri S.Raffaele University Hospital Milan 61 CONGRESSO NAZIONALE SIGG, Napoli, 2016 Bulk of Population Growth The Economist,
More informationRecent observations have focused attention on the PVs as a source of ectopic activity i determining i AF
Atrial Fibrillation in 2010 Panos Vardas Professor of Cardiology President of EHRA Atrial Fibrillation Pathophysiology of AF Triggers Recent observations have focused attention on the PVs as a source of
More informationLa Terapia Medica della Fase Cronica: dati attuali e prospettive future. Michele Senni Cardiologia 1
La Terapia Medica della Fase Cronica: dati attuali e prospettive future Michele Senni Cardiologia 1 Probability of death in Heart Failure: IN-HF Registry Cumulative one-year mortality rate 27.2% 19.2%
More informationHalf Moon Bay Treatment of Atrial Fibrillation. Dr. Roger A. Winkle MD. Silicon Valley Cardiology, PAMF, Sutter Health Sequoia Hospital
Half Moon Bay 2018 Treatment of Atrial Fibrillation Dr. Roger A. Winkle MD Silicon Valley Cardiology, PAMF, Sutter Health Sequoia Hospital Disclosures: Investor Farapulse Things a Primary Care Doctor Should
More informationUpdate in the Management of Atrial Fibrillation
Update in the Management of Atrial Fibrillation Gregory M Marcus, MD, MAS Associate Professor of Medicine Division of Cardiology University of California, San Francisco Disclosures Research: Gilead, Medtronic,
More informationSupplementary Online Content
Supplementary Online Content Morillo CA, Verma A, Connolly SJ, et al. Radiofrequency ablation vs antiarrhythmic drugs as first-line Treatment of Paroxysmal Atrial Fibrillation (RAAFT-2): a randomzied clinical
More informationANTIPAF Angiotensin II Antagonist in Paroxysmal Atrial Fibrillation Trial
European Society of Cardiology Hotline Stockholm - Zone K 31 st August 2010 Placebo ARB Kumagai K, et al. JACC 2003 Discussant ANTIPAF Angiotensin II Antagonist in Paroxysmal Atrial Fibrillation Trial
More informationIndex. cardiology.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A AADs. See Antiarrhythmic drugs (AADs) ACE inhibitors. See Angiotensin-converting enzyme (ACE) inhibitors ACP in transseptal approach to
More informationThe pill-in-the-pocket strategy for paroxysmal atrial fibrillation
The pill-in-the-pocket strategy for paroxysmal atrial fibrillation KONSTANTINOS P. LETSAS, MD, FEHRA LABORATORY OF CARDIAC ELECTROPHYSIOLOGY EVANGELISMOS GENERAL HOSPITAL OF ATHENS ARRHYTHMIAS UPDATE,
More informationAntiarrhythmics for Atrial Fibrillation: Practical Implications of Latest Clinical Developments CME
Antiarrhythmics for Atrial Fibrillation: Practical Implications of Latest Clinical Developments CME A. John Camm, MD; Stuart J. Connolly, MD; Jean-Yves F. Le Heuzey, MD CME Released: 12/08/2011; Valid
More informationTreatment strategy decision tree
strategy decision tree strategy decision tree Confirmed diagnosis of AF Further investigations and clinical assessment including risk stratification for stroke/thromboembolism Paroxysmal AF Persistent
More informationControversies in Atrial Fibrillation and HF
Controversies in Atrial Fibrillation and HF Dr.Yahya Al Hebaishi Cardiac electrophysiology division, PSCC, Riyadh Atrial Fibrillation: Rate or Rhythm? HF and AF: the twin epidemic of cardiovascular disease.
More informationATHENA - A placebo-controlled, double-blind, parallel arm Trial to assess the efficacy of dronedarone 400 mg bid for the prevention of cardiovascular
1 ATHENA - A placebo-controlled, double-blind, parallel arm Trial to assess the efficacy of dronedarone 400 mg bid for the prevention of cardiovascular Hospitalization or death from any cause in patients
More informationClinical Investigations
Clinical Investigations Effects of Dronedarone Started Rapidly After Amiodarone Discontinuation Address for correspondence: Laura Immordino, MD 100 E. Lancaster Avenue Wynnewood, PA 19096 laura.immordino@gmail.com
More information5/5/2010. World incidence 720, 000 new cases / year. World prevalence 5.55 million AF prevalence increasing with aging of population
Atrial Fibrillation: Guidelines through clinical cases and 2010 updates Samy Claude ELAYI Cardiac Clinical Pacing and Electrophysiology UK World incidence 720, 000 new cases / year World prevalence 5.55
More informationAF :RHYTHM CONTROL BY DR-MOHAMMED SALAH ASSISSTANT LECTURER CARDIOLOGY DEPARTMENT
AF :RHYTHM CONTROL BY DR-MOHAMMED SALAH ASSISSTANT LECTURER CARDIOLOGY DEPARTMENT 5-2014 Atrial Fibrillation therapeutic Approach Rhythm Control Thromboembolism Prevention: Recommendations Direct-Current
More informationShould I use statins?
I know the trials in heart failure but how do I manage my patient? Should I use statins? Aldo P Maggioni, MD, FESC ANMCO Research Center Firenze, Italy Disclosures Aldo P Maggioni served as a member of
More informationEuropean Heart Rhythm Association launches a practical guide on new oral anticoagulants in atrial fibrillation
European Heart Journal (2013) 34, 791 795 doi:10.1093/eurheartj/eht051 European Heart Rhythm Association launches a practical guide on new oral anticoagulants in atrial fibrillation The European Heart
More informationESC Guidelines. ESC Guidelines Update For internal training purpose. European Heart Journal, doi: /eurheart/ehn309
ESC Guidelines Update 2008 ESC Guidelines Heart failure update 2008 For internal training purpose. 0 Agenda Introduction Classes of recommendations Level of evidence Treatment algorithm Changes to ESC
More informationAtrial Fibrillation: Guidelines through clinical cases and 2010 updates
Atrial Fibrillation: Guidelines through clinical cases and 2010 updates Samy Claude ELAYI Cardiac Clinical Pacing and Electrophysiology World incidence 720, 000 new cases / year World prevalence 5.5 million
More informationABLATION OF CHRONIC AF
ABLATION OF CHRONIC AF A PISAPIA ST JOSEPH HOSPITAL MARSEILLE MEET 2008 Atrial Fibrillation The most common significant heart rhythm disturbance Incidence increases with age and the development of structural
More information3/25/2017. Program Outline. Classification of Atrial Fibrillation
Alternate Strategies to Antiarrhythmic Therapy: The Role of Ablation Jennifer El Aile, MS, AGPCNP-BC Electrophysiology Nurse Practitioner Clinical Lecturer at the University of Michigan Program Outline
More informationThe 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 informationAF and arrhythmia management. Dr Rhys Beynon Consultant Cardiologist and Electrophysiologist University Hospital of North Staffordshire
AF and arrhythmia management Dr Rhys Beynon Consultant Cardiologist and Electrophysiologist University Hospital of North Staffordshire Atrial fibrillation Paroxysmal AF recurrent AF (>2 episodes) that
More informationEFFECTIVE SHARED CARE AGREEMENT. Dronedarone - For the treatment and management of atrial fibrillation
EFFECTIVE SHARED CARE AGREEMENT Dronedarone - For the treatment and management of atrial fibrillation Specialist details Patient identifier Name INTRODUCTION This shared care agreement outlines how the
More informationManagement of atrial fibrillation in heart failure
Nationale hartfalendag 2017 Zeist Management of atrial fibrillation in heart failure Isabelle C Van Gelder University of Groningen University Medical Center Groningen The Netherlands Disclosures Grant
More informationStuart Beldner, MD, FHRS Assistant Professor NSLIJ Hofstra School of Med
Stuart Beldner, MD, FHRS Assistant Professor NSLIJ Hofstra School of Med None There s no reason to panic. While it is true that one of the crew members is ill, slightly. Absence of discrete P waves Chaotic
More informationA patient with decompensated HF
A patient with decompensated HF Professor Michel KOMAJDA University Pierre & Marie Curie Pitie Salpetriere Hospital Department of Cardiology Paris (France) Declaration Of Interest 2010 Speaker : Servier,
More informationESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure
Patients t with acute heart failure frequently develop chronic heart failure Patients with chronic heart failure frequently decompensate acutely ESC Guidelines for the Diagnosis and A clinical response
More informationConflicts of interest
Conflicts of interest Disclosure forms of all Task Force members and reviewers are available on the ESC Website http://www.escardio.org/guidelines ESC Guidelines on the diagnosis and treatment of peripheral
More informationHypertension and Atrial Fibrillation in 2017
Boma Inn, Eldoret, 24th 25thFebruary 2017 Hypertension and Atrial Fibrillation in 2017 Dr Mzee Ngunga Consultant Cardiologist Aga Khan University Hospital, Nairobi Objectives 1. Understand the relationship
More informationHow Do I Balance Bradycardia with Rate Control in Atrial Fibrillation?
How Do I Balance Bradycardia with Rate Control in Atrial Fibrillation? Thang Nguyen MD FRCPC Assistant Professor Section of Cardiology Department of Internal Medicine University of Manitoba Objectives
More informationPrimary Care Update in Medicine January 31 February 1, 2013 New Management Options for Patients with Atrial Fibrillation
Primary Care Update in Medicine January 31 February 1, 2013 New Management Options for Patients with Atrial Fibrillation Anne B. Curtis, MD, FACC, FHRS, FACP, FAHA Charles and Mary Bauer Professor, Chair,
More informationProfessor DA Fitzmaurice Primary Care Clinical Sciences University of Birmingham
New Guidelines for SPAF Professor DA Fitzmaurice Primary Care Clinical Sciences University of Birmingham Stroke prevention and atrial fibrillation Epidemiology of atrial fibrillation How common is it?
More informationAtrial fibrillation and mortality: where is the missing link? Isabelle C Van Gelder University Medical Center Groningen
Atrial fibrillation and mortality: where is the missing link? Isabelle C Van Gelder The Netherlands Madrid Europace June 2011 Conflict of interests Research grants from Medtronic, SJM, Biotronik, Boston,
More informationRole of Dronedarone in Atrial Fibrillation: More Questions Than Answers
Role of Dronedarone in Atrial Fibrillation: More Questions Than Answers Daniel E. Hilleman, Pharm.D., FCCP, and Aryan N. Mooss, M.D. Key Words: dronedarone, atrial fibrillation, sinus rhythm, hypertension,
More informationCatheter Ablation for AF: Patients, Procedures, Outcomes
Catheter Ablation for AF: Patients, Procedures, Outcomes John Sapp Director Heart Rhythm, QEII Health Sciences Centre Professor of Medicine, Dalhousie University Atrial Fibrillation Atrial Fibrillation
More informationNew evidences in heart failure: the GISSI-HF trial. Aldo P Maggioni, MD ANMCO Research Center Firenze, Italy
New evidences in heart failure: the GISSI-HF trial Aldo P Maggioni, MD ANMCO Research Center Firenze, Italy % Improving survival in chronic HF and LV systolic dysfunction: 1 year all-cause mortality 20
More informationKenneth W. Mahaffey, MD and Keith AA Fox, MB ChB
Once-daily oral direct factor Xa inhibition Compared with vitamin K antagonism for prevention of stroke and Embolism Trial in Atrial Fibrillation Kenneth W. Mahaffey, MD and Keith AA Fox, MB ChB on behalf
More informationJay Simonson, MD, FACC, FHRS Medical Director, Cardiac Electrophysiology Park Nicollet Heart and Vascular Center
Jay Simonson, MD, FACC, FHRS Medical Director, Cardiac Electrophysiology Park Nicollet Heart and Vascular Center A-Fib Facts Yes, you may be able to blame your parents It is more of a nuisance than a
More informationΚΑΤΑΛΥΣΗ ΚΟΛΠΙΚΗΣ ΜΑΡΜΑΡΥΓΗΣ. ΥΠΕΡ. Michalis Efremidis MD Second Department of Cardiology Evangelismos General Hospital
ΚΑΤΑΛΥΣΗ ΚΟΛΠΙΚΗΣ ΜΑΡΜΑΡΥΓΗΣ. ΥΠΕΡ. Michalis Efremidis MD Second Department of Cardiology Evangelismos General Hospital Rate control versus Rhythm control for Atrial Fibrillation AFFIRM N Engl J Med 2002;347:1825-33
More informationDronedarone in patients with congestive heart failure: insights from ATHENA
European Heart Journal (2010) 31, 1717 1721 doi:10.1093/eurheartj/ehq113 CLINICAL RESEARCH Heart failure/cardiomyopathy Dronedarone in patients with congestive heart failure: insights from ATHENA Stefan
More informationCurrent Guideline for AF Treatment. Young Keun On, MD, PhD, FHRS Samsung Medical Center Sungkyunkwan University School of Medicine
Current Guideline for AF Treatment Young Keun On, MD, PhD, FHRS Samsung Medical Center Sungkyunkwan University School of Medicine Case 1 59 year-old lady Sudden palpitation and breathlessness for 12 hours
More informationOut with the old, in with The 2010 Atrial Fibrillation Guidelines
Out with the old, in with The 2010 Atrial Fibrillation Guidelines Kseniya Chernushkin B.Sc.(Pharm.), VCH/PHC Pharmacy Resident Mary Elliot B.Sc.(Pharm.), VCH/PHC Pharmacy Resident March 22, 2011 Outline
More informationDISCLAIMER: 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 informationRate or Rhythm Control? Epidemiology. Relevant Advances in Atrial Fibrillation 6/20/2011. Stroke Prophylaxis
Relevant Advances in Atrial Fibrillation Stroke Prophylaxis Managing Atrial Fibrillation: Tips for the Generalist Antiarrhythmic Drug Therapy Ablation Gregory M Marcus, MD, MAS Assistant Professor of Medicine
More informationBasics of Atrial Fibrillation. By Mini Thannikal NP-BC Mount Sinai St Luke s Hospital New York, NY
Basics of Atrial Fibrillation By Mini Thannikal NP-BC Mount Sinai St Luke s Hospital New York, NY Atrial Fibrillation(AF) is a supraventricular tachyarrhythmia characterized by uncoordinated atrial activation
More informationRhythm Control: Is There a Role for the PCP? Blake Norris, MD, FACC BHHI Primary Care Symposium February 28, 2014
Rhythm Control: Is There a Role for the PCP? Blake Norris, MD, FACC BHHI Primary Care Symposium February 28, 2014 Financial disclosures Consultant Medtronic 3 reasons to evaluate and treat arrhythmias
More informationDronedarone for the treatment of atrial fibrillation and atrial flutter
National Institute for Health and Clinical Excellence Dronedarone for the treatment of atrial fibrillation and atrial flutter Comment 1: the draft remit Appropriateness Sanofi-aventis Sanofi-aventis believe
More informationPractical Rate and Rhythm Management of Atrial Fibrillation
Practical Rate and Rhythm Management of Atrial Fibrillation pocket guide UPDATED FEBRUARY 2013 Adapted from the ACCF/AHA/HRS 2011 Focused Updates Incorporated into the ACC/AHA/ESC Guidelines for the Management
More informationAtrial fibrillation workshop: rate- versus rhythm-control
Atrial fibrillation workshop: rate- versus rhythm-control Rocky Mountain Internal Medicine Conference Nov, 2011 Dr F. Russell Quinn Cardiac Electrophysiologist, Foothills Medical Centre, Calgary Disclosures
More informationInnovations in AF Management
Innovations in AF Management Barry Boilson MD PhD FRCPI boilson.barry@mayo.edu Disclosures Relevant None financial relationship(s) with industry None Off Label Usage None Overview Mechanisms of AF AF as
More informationAtrial 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 informationDECLARATION OF CONFLICT OF INTEREST. Consultant Sanofi Biosense Webster Honorarium Boehringer Ingelheim St Jude Medical
DECLARATION OF CONFLICT OF INTEREST Consultant Sanofi Biosense Webster Honorarium Boehringer Ingelheim St Jude Medical ESC Congress Paris, France August 27-31, 2011 Risk & Complications of AADs for Rhythm
More informationAF Today: W. For the majority of patients with atrial. are the Options? Chris Case
AF Today: W hat are the Options? Management strategies for patients with atrial fibrillation should depend on the individual patient. Treatment with medications seems adequate for most patients with atrial
More informationNHS Kent and Medway Medicines Management. Dronedarone (Multaq ) Shared Care Guideline For Prescribing
NHS Kent and Medway Medicines Management Dronedarone (Multaq ) Shared Care Guideline For Prescribing Issue No: 2 Review Date (If Applicable): Accountable Officer: Heather Lucas Contact Details: 01233 618158
More information