Who Gets Atrial Fibrilla9on..?

Size: px
Start display at page:

Download "Who Gets Atrial Fibrilla9on..?"

Transcription

1 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 Inc, Xen9on Ltd. and Founder, Electus Medical Inc. Prevalence of AF predicted to more than double by 2050 Patients with atrial fibrillation (millions) ,1 5,1 5,9 5,6 6,7 6,1 2,08 2,26 2,44 2,66 7,7 6,8 2,94 8,9 7,5 3,33 10,2 8,4 3,8 11,7 9,4 4,34 13,1 10,3 4,78 14,3 11,1 5,16 15,2 11,7 15,9 12,1 5,42 5, Year Assuming a con9nued increase in the AF incidence Assuming no further increase in the AF incidence ATRIA study data Miyasaki Y et al. Circula9on 2006;114: Older Metabolic disease Hypertension Coronary disease Heart Failure Who Gets Atrial Fibrilla9on..? Any History of Physical Ac9vity in Your Family Gold Standard:- Electrocardiogram Paroxysmal and Persistent Atrial Fibrilla9on Regular rhythm P Irregularly irregular rhythm Normal sinus rhythm AF Normal heart rate Regular rhythm P waves Steady baseline Heart rate increased (tachyarrhythmia)* Irregularly irregular rhythm No P wave *Reduced heart rate (bradyarrhythmia) may also be observed Ashley EA, Niebauer J. Cardiology Explained. Remedica: London 2004 Camm et al. Eur Heart J 2010;31:

2 Ambulatory ECG monitor Con9nuous monitoring for a short period of 9me (typically 24 hours) Useful for: Detec9ng asymptoma9c AF Evalua9ng pa9ents with paroxysmal AF Assessing response to treatment Strategic Op9ons in Atrial Fibrilla9on Symptoms of Atrial Fibrilla9on Atrial Fibrilla9on may be very symptoma9c Strategic Op9ons in Atrial Fibrilla9on 2

3 RATE CONTROL OF ATRIAL FIBRILLATION Conven9onal An9arrhythmic Drugs for AF Cumula9ve Mortality (%) Rhythm Control vs. Rate Control (The AFFIRM Trial) Rhythm Control Rate Control N = 4060 pa9ents, FU 5 years > 65 yr or other RF for Stroke or Death P=0.08 Years (%) D.G. Wyse et al. NEJM 2002; 347:1825 Rate Control in Atrial Fibrilla9on Rate Control Op9ons RHYTHM CONTROL OF ATRIAL FIBRILLATION Selecting the right drug for the patient: Recommendations for AADs used to treat AF Sotalol Flecainide Amiodarone Dronedarone Maintenance of sinus Treatment of paroxysmal Treatment of severe rhythm Maintenance of sinus rhythm following conversion AF, when other treatment is disorders, when other AADs rhythm in clinically stable of AF ineffective have failed paroxysmal or persistent AF Torsades de pointes (at doses effective for AAD) Exacerbation of ischaemic heart disease following sudden discontinuation Risk of pro-arrhythmia Cardiac toxicity Hepatotoxicity Pulmonary toxicity Neuropathy Visual problems Hepatotoxicity (very rare) Pulmonary toxicity (very rare) Stroke or cardiac mortality in permanent AF patients AAD: anti-arrhythmic drug. AF: Atrial fibrillation. BMI: Body mass index. CHF: Congestive heart failure. COPD: Chronic obstructive pulmonary disease. ECG: Electrocardiogram. LV: Left ventricular. LVEF: LV ejection fraction. LVSD: LV systolic dysfunction. MI: Myocardial infarction. 3

4 Selecting the right drug for the patient: Recommendations for AADs used to treat AF Sotalol Flecainide Amiodarone Dronedarone Maintenance of sinus Treatment of paroxysmal Treatment of severe rhythm Maintenance of sinus rhythm following conversion AF, when other treatment is disorders, when other AADs rhythm in clinically stable of AF ineffective have failed paroxysmal or persistent AF Torsades de pointes (at doses effective for AAD) Exacerbation of ischaemic heart disease following sudden discontinuation Risk of pro-arrhythmia Cardiac toxicity Hepatotoxicity Pulmonary toxicity Neuropathy Visual problems Hepatotoxicity (very rare) Pulmonary toxicity (very rare) Stroke or cardiac mortality in permanent AF patients Ectopic focus leads to wavefront from LSPV invading LA body Appropriate condi9ons of heterogeneity lead to wave break with counter- rota9ng vor9ces AAD: anti-arrhythmic drug. AF: Atrial fibrillation. BMI: Body mass index. CHF: Congestive heart failure. COPD: Chronic obstructive pulmonary disease. ECG: Electrocardiogram. LV: Left ventricular. LVEF: LV ejection fraction. LVSD: LV systolic dysfunction. MI: Myocardial infarction. Jalife et al. Cardiovasc Res : Atrial Fibrilla9on and Amiodarone Atrial Fibrilla9on and Amiodarone N Engl J Med Mar 1;356(9): N Engl J Med Mar 1;356(9): Patients without AFib (%) Amiodarone to Prevent Recurrence of AF CTAF Study: mean follow-up 16 months 100 p< Amiodarone Sotalol Propafenone Follow-up (days) Conventional Antiarrhythmic Drugs for AF ACC/AHA/ESC 2006 guidelines for the management of AF No Heart Disease Flecanide Sotalol AMIODARONE Catheter Ablation Coronary Artery Disease Sotalol AMIODARONE Catheter Ablation Heart Failure or Hypertension with LVH AMIODARONE Catheter Ablation Roy D, et al. N Engl J Med 2000; 342:913 Fuster et al, Circulation 2006;108:1979 4

5 Amiodarone is a difficult drug Acute Liver Failure associated with Dronedarone 70-year old female 6-month Rx Dronedarone Hepatic encephaolopathy A. Cholestatic organ B. Widespread necrosis C. Canalicular cholestasis D. Mixed pattern of inflammatory cells Joghetaei et al. Circ Arrhythm Electrophysiol 2011;4; Selecting the right drug for the patient: Recommendations for AADs used to treat AF Sotalol Flecainide Amiodarone Dronedarone Not used in patients with: Not used in patients with: Not used in patients with: Not used in patients with: COPD and asthma LV hypertrophy Thyroid dysfunction Permanent AF, no LV hypertrophy (LVEF < 40%) Sinus bradycardia restoration of sinus rhythm (LVEF < 40%) Heart failure Heart failure Renal failure or low BMI Coronary artery disease LVSD or LVEF < 40% Heart failure CHF or history of MI Severe hepatic or renal Sinus bradycardia Longstanding AF, no impairment restoration of sinus rhythm Sinus bradycardia Previous lung or liver toxicity from amiodarone use Initiate in secondary care with ECG Initiate in secondary care with ECG Initiate only in hospital or Initiate under specialist under specialist supervision supervision AAD: anti-arrhythmic drug. AF: Atrial fibrillation. BMI: Body mass index. CHF: Congestive heart failure. COPD: Chronic obstructive pulmonary disease. ECG: Electrocardiogram. LV: Left ventricular. LVEF: LV ejection fraction. LVSD: LV systolic dysfunction. MI: Myocardial infarction. Systems Approach to Atrial Fibrillation CLINICAL PHENOTYPES (A) GENETICS (B) NEW DRUG DEVELOPMENT SYSTEMS ARCHITECTURE (computation) MOLECULAR, CELLULAR, WHOLE HEART AND SIMULATION STUDIES (C) CLINICAL CARE Improved taxonomy Prevention Targeted therapeutics 5

6 Extending the ARP Safely modulate only atrial channels Efficacy in Human Tissue Atrial Tissue Ventricular Tissue 0 mv Kv1.5 IKACh Targe9ng atrium- specific channels avoids the risk of QT Very few channels are expressed only in the atria Our preferred targets: Kv mv IKACh (aka Kir3.1/3.4) Human Atrial Myocyte XEN- D0101 selec9vely prolongs ARP Ideal profile for an AF therapeu9c Disease Ion Channel Discovery Pre-Clinical Clinical Development Indication Target Development Phase I Phase II Atrial Fibrillation Kv1.5 IKACh XEN-D0103 Collaborative Research Ono Pharmaceutical Co Ltd Grünenthal GmbH INITIAL ASSESSMENT CONCLUSIONS Stroke risk Causes lifestyle/echocardiogram Quality of life 6

7 STRATEGIC OPTIONS CONSIDER REFERRAL Rate control beta block/calcium channel blocker Rhythm control beta block/an9arrhythmic Refer Rate control difficult Younger pa9ents Pa9ents with hospital admissions 7

Are Drugs Better? Dr Mauro Lencioni. Drugs or ablation as first line treatment for AF? Consultant Cardiologist & Electrophysiologist

Are 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 information

Rate and Rhythm Control of Atrial Fibrillation

Rate 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 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

Supplementary Online Content

Supplementary 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 information

ABLATION OF CHRONIC AF

ABLATION 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 information

ΚΑΤΑΛΥΣΗ 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 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 information

» A new drug s trial

» 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 information

5/5/2010. World incidence 720, 000 new cases / year. World prevalence 5.55 million AF prevalence increasing with aging of population

5/5/2010. 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 information

Atrial Fibrillation: Guidelines through clinical cases and 2010 updates

Atrial 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 information

AF 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 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 information

Treatment of Atrial Fibrillation in Heart Failure

Treatment 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 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

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

AF Today: W. For the majority of patients with atrial. are the Options? Chris Case

AF 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 information

Understanding Atrial Fibrillation Management. Roy Lin, MD

Understanding 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 information

Polypharmacy - arrhythmic risks in patients with heart failure

Polypharmacy - 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 information

Debate PRO. Dronedarone is an important drug in the management of paroxysmal atrial fibrillation. John Camm

Debate 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 information

Basics 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 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 information

Atrial fibrillation (AF) is a disorder seen

Atrial fibrillation (AF) is a disorder seen This Just In... An Update on Arrhythmia What do recent studies reveal about arrhythmia? In this article, the authors provide an update on atrial fibrillation and ventricular arrhythmia. Beth L. Abramson,

More information

Use 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 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 information

Progression of atrial fibrillation: can we prevent it? Early catheter ablation will stop progression of atrial fibrillation pro

Progression of atrial fibrillation: can we prevent it? Early catheter ablation will stop progression of atrial fibrillation pro Progression of atrial fibrillation: can we prevent it? Early catheter ablation will stop progression of atrial fibrillation pro Jerónimo Farré MD, Madrid, ES AF: the kingdom of wishful thinking In AF we

More information

Is Atrial Fibrillation preventable?

Is Atrial Fibrillation preventable? Heart Rhythm Congress, Birmingham, 11 th October 2016 Is Atrial Fibrillation preventable? The interplay between genetic and environmental factors in genesis of AF Andrew Grace University of Cambridge -

More information

Samer Nasr, M.D. Mount Lebanon Hospital.

Samer 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 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

Cost and Prevalence of A fib. Atrial Fibrillation: Guideline Directed Treatment. Prevalence of A Fib. Risk Factors for A Fib. Risk Factors for A Fib

Cost 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 information

Arrhythmias and Heart Failure Dr Chris Lang Consultant Cardiologist and Electrophysiologist Royal Infirmary of Edinburgh

Arrhythmias and Heart Failure Dr Chris Lang Consultant Cardiologist and Electrophysiologist Royal Infirmary of Edinburgh Arrhythmias and Heart Failure Dr Chris Lang Consultant Cardiologist and Electrophysiologist Royal Infirmary of Edinburgh Arrhythmias and Heart Failure Ventricular Supraventricular VT/VF Primary prevention

More information

How atrial fibrillation should be treated in the heart failure patient?

How atrial fibrillation should be treated in the heart failure patient? Advances in Cardiac Arrhhythmias and Great Innovations in Cardiology Torino, 13/15 Ottobre 2016 How atrial fibrillation should be treated in the heart failure patient? Matteo Anselmino Dipartimento Scienze

More information

Catheter ablation is not a class I indication after failed antiarrhythmic drugs

Catheter ablation is not a class I indication after failed antiarrhythmic drugs Catheter ablation is not a class I indication after failed antiarrhythmic drugs Martin Jan Schalij Department of Cardiology Leiden University Medical Center Disclosure: Research grants from: Boston Scientific

More information

Drugs Controlling Myocyte Excitability and Conduction at the AV node Singh and Vaughan-Williams Classification

Drugs Controlling Myocyte Excitability and Conduction at the AV node Singh and Vaughan-Williams Classification Drugs Controlling Myocyte Excitability and Conduction at the AV node Singh and Vaughan-Williams Classification Class I Na Channel Blockers Flecainide Propafenone Class III K channel Blockers Dofetilide,

More information

Interventional solutions for atrial fibrillation in patients with heart failure

Interventional solutions for atrial fibrillation in patients with heart failure Interventional solutions for atrial fibrillation in patients with heart failure Advances in Cardiovascular Arrhythmias Great Innovations in Cardiology Matteo Anselmino, MD PhD Division of Cardiology Department

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

What s New in the AF Guidelines

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 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

How do arrhythmias occur?

How do arrhythmias occur? How do arrhythmias occur? An arrhythmia is an abnormal heart rhythm (= dysrhythmia). Can be fast (tachy) or slow (brady). Brady arrhythmias are usually due to conduc;on block, while tachyarrhythmias are

More information

Amiodarone Prescribing and Monitoring: Back to the Future

Amiodarone Prescribing and Monitoring: Back to the Future Amiodarone Prescribing and Monitoring: Back to the Future Subha L. Varahan, MD, FHRS, CCDS Electrophysiologist Oklahoma Heart Hospital Oklahoma City, OK Friday, February, 8 th, 2019 Iodinated benzofuran

More information

Ablation Should Not Be Used as Primary Therapy for Treatment of Patients with Atrial Fibrillation

Ablation Should Not Be Used as Primary Therapy for Treatment of Patients with Atrial Fibrillation Ablation Should Not Be Used as Primary Therapy for Treatment of Patients with Atrial Fibrillation 25 October 2008 Update in Electrocardiography and Arrhythmias Zian H. Tseng, M.D., M.A.S. Assistant Professor

More information

Management strategies for atrial fibrillation Thursday, 20 October :27

Management strategies for atrial fibrillation Thursday, 20 October :27 ALTHOUGH anyone who has had to run up a flight of steps or has had a frightening experience is quite familiar with a racing heartbeat, for the more than 2 million Americans who suffer from atrial fibrillation

More information

Dysrhythmias 11/7/2017. Disclosures. 3 reasons to evaluate and treat dysrhythmias. None. Eliminate symptoms and improve hemodynamics

Dysrhythmias 11/7/2017. Disclosures. 3 reasons to evaluate and treat dysrhythmias. None. Eliminate symptoms and improve hemodynamics Dysrhythmias CYDNEY STEWART MD, FACC NOVEMBER 3, 2017 Disclosures None 3 reasons to evaluate and treat dysrhythmias Eliminate symptoms and improve hemodynamics Prevent imminent death/hemodynamic compromise

More information

The pill-in-the-pocket strategy for paroxysmal atrial fibrillation

The 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 information

AF :RHYTHM CONTROL BY DR-MOHAMMED SALAH ASSISSTANT LECTURER CARDIOLOGY DEPARTMENT

AF :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 information

Half Moon Bay Treatment of Atrial Fibrillation. Dr. Roger A. Winkle MD. Silicon Valley Cardiology, PAMF, Sutter Health Sequoia Hospital

Half 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 information

Treatment strategy decision tree

Treatment 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 information

Synopsis of Management on Ventricular arrhythmias. M. Soni MD Interventional Cardiologist

Synopsis of Management on Ventricular arrhythmias. M. Soni MD Interventional Cardiologist Synopsis of Management on Ventricular arrhythmias M. Soni MD Interventional Cardiologist No financial disclosure Premature Ventricular Contraction (PVC) Ventricular Bigeminy Ventricular Trigeminy Multifocal

More information

Dronedarone for the treatment of non-permanent atrial fibrillation

Dronedarone 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 information

What s new in my specialty?

What s new in my specialty? What s new in my specialty? Jon Melman, MD Heart Rhythm Specialists McKay-Dee Hospital some would say some would say my specialty 1 some would say my specialty First pacemaker 1958 some would say my specialty

More information

AF ABLATION Concepts and Techniques

AF ABLATION Concepts and Techniques AF ABLATION Concepts and Techniques Antony F Chu, M.D. Director of Complex Ablation Arrhythmia Services Section Division of Cardiology at the Rhode Island and Miriam Hospital HIGHLIGHTS The main indications

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

Catheter Ablation for AF: Patients, Procedures, Outcomes

Catheter 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 information

Dronedarone 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 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 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

Rhythm 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 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 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

Jay 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 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 information

How does the heart work? The heart is muscle whose main function is a pump; to push blood the rest of your body.

How does the heart work? The heart is muscle whose main function is a pump; to push blood the rest of your body. 1 You have a condition called atrial fibrillation. I would like you to learn more about this condition. You should read about it below, and can also watch an Internet program about it. After reading about

More information

Dronedarone: Need to Perform a CV Outcome Safety Study

Dronedarone: 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 information

Antiarrhythmic agents in 2014

Antiarrhythmic 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 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

La terapia non anticoagulante nel paziente con FA secondo le Linee Guida F. CONROTTO

La terapia non anticoagulante nel paziente con FA secondo le Linee Guida F. CONROTTO La terapia non anticoagulante nel paziente con FA secondo le Linee Guida F. CONROTTO Rhythm or rate control strategy? N Engl J Med 2002;347:1834 40 Rate Control versus Electrical Cardioversion for Persistent

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

Atrial Fibrillation New Approaches, Techniques, and Technology

Atrial Fibrillation New Approaches, Techniques, and Technology New Cardiovascular Horizons 2015 May 28, 2015 New Orleans, Louisiana Atrial Fibrillation New Approaches, Techniques, and Technology State of the Art - - 2015 Richard Abben, M D Director, Cardiac Arrhythmia

More information

AF#in#pa(ents#with#CAD# Is#dronedarone#a#good#choice?!

AF#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 information

Atrial fibrillation and advanced age

Atrial fibrillation and advanced age Atrial fibrillation and advanced age Prof. Fiorenzo Gaita Director of the Cardiology School University of Turin, Italy Prevalence of AF in the general population Prevalence and age distribution in patients

More information

Recent observations have focused attention on the PVs as a source of ectopic activity i determining i AF

Recent 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 information

ATHENA - A placebo-controlled, double-blind, parallel arm Trial to assess the efficacy of dronedarone 400 mg bid for the prevention of cardiovascular

ATHENA - 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 information

National Horizon Scanning Centre. Dronedarone (Multaq) for atrial fibrillation and atrial flutter. December 2007

National 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 information

Atrial Fibrillation 2009

Atrial 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 information

DECLARATION 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 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 information

Arrhythmias (I) Supraventricular Tachycardias. Disclosures

Arrhythmias (I) Supraventricular Tachycardias. Disclosures Arrhythmias (I) Supraventricular Tachycardias Amy Leigh Miller, MD, PhD Cardiovascular Electrophysiology, Brigham & Women s Hospital Disclosures None Short R-P Tachycardia REGULAR with 1:1 P/R relationship

More information

Atrial Fibrillation and the NOAC s. John Raymond MS, PA-C, MHP February 10, 2018

Atrial Fibrillation and the NOAC s. John Raymond MS, PA-C, MHP February 10, 2018 Atrial Fibrillation and the NOAC s John Raymond MS, PA-C, MHP February 10, 2018 Pathogenesis EPIDEMIOLOGY Arrhythmia-related hospitalisations in the US Ventricular fibrillation 2% Atrial fibrillation 34%

More information

Is cardioversion old hat? What is new in interventional treatment of AF symptoms?

Is cardioversion old hat? What is new in interventional treatment of AF symptoms? Is cardioversion old hat? What is new in interventional treatment of AF symptoms? Joseph de Bono Consultant Electrophysiologist University Hospitals Birmingham Atrial Fibrillation (AF) Affects 2% of the

More information

Rebuttal. Jerónimo Farré MD 2010

Rebuttal. Jerónimo Farré MD 2010 Rebuttal 1.We do not know what are the types of AF in which ablation is worthless or most effective 2.Waiting implies to consider the ablation at an older age and when the duration of the history of AF

More information

Congestive Heart Failure or Heart Failure

Congestive Heart Failure or Heart Failure Congestive Heart Failure or Heart Failure Dr Hitesh Patel Ascot Cardiology Group Heart Failure Workshop April, 2014 Question One What is the difference between congestive heart failure and heart failure?

More information

Atrial Fibrillation Cases. Dr Paul Broadhurst Consultant Cardiologist

Atrial Fibrillation Cases. Dr Paul Broadhurst Consultant Cardiologist Atrial Fibrillation Cases Dr Paul Broadhurst Consultant Cardiologist November 2011 Mr TH age 72 Routine medical for hypertension check Denies any symptoms despite close questioning PMH: hypertension, MI,

More information

Consensus document: Screening and Prevention of Atrial Fibrillation

Consensus document: Screening and Prevention of Atrial Fibrillation Consensus document: Screening and Prevention of Atrial Fibrillation Yong-Seog Oh, M.D.,Ph.D. Division of Cardiology, Department of Internal Medicine, Seoul St. Mary s Hospital, College of Medicine, The

More information

Arrhythmia 341. Ahmad Hersi Professor of Cardiology KSU

Arrhythmia 341. Ahmad Hersi Professor of Cardiology KSU Arrhythmia 341 Ahmad Hersi Professor of Cardiology KSU Objectives Epidemiology and Mechanisms of AF Evaluation of AF patients Classification of AF Treatment and Risk stratification of AF Identify other

More information

EHRA/EUROPACE 2011 Madrid, Spain June

EHRA/EUROPACE 2011 Madrid, Spain June EHRA/EUROPACE 2011 Madrid, Spain June 26.-29.2011 Implementing modern management in atrial fibrillation patients Proceedings from the 3rd AFNet/EHRA consensus conference EHRA Special Session Different

More information

Atrial Fibrillation and Common Supraventricular Tachycardias. Sunil Kapur MD

Atrial Fibrillation and Common Supraventricular Tachycardias. Sunil Kapur MD Atrial Fibrillation and Common Supraventricular Tachycardias Sunil Kapur MD Cardiac Electrophysiology Brigham and Women s Hospital Instructor, Harvard Medical School No disclosures Cardiac Conduction:

More information

3/25/2017. Program Outline. Classification of Atrial Fibrillation

3/25/2017. 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 information

Role of Dronedarone in Atrial Fibrillation: More Questions Than Answers

Role 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 information

Dronedarone For Atrial Fibrillation: Unbridled Enthusiasm Or Just Another Small Step Forward?

Dronedarone 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 information

Current 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 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 information

The EP Perspective: Should We Do Hybrid Ablation, and Who Should We Do It On?

The EP Perspective: Should We Do Hybrid Ablation, and Who Should We Do It On? The EP Perspective: Should We Do Hybrid Ablation, and Who Should We Do It On? L. Pison, MD PhD FESC AATS Surgical Treatment of Arrhythmias and Rhythm Disorders November 17-18, 2017 Miami Beach, FL, USA

More information

Atrial Fibrillation 10/2/2018. Depolarization & ECG. Atrial Fibrillation. Hemodynamic Consequences

Atrial Fibrillation 10/2/2018. Depolarization & ECG. Atrial Fibrillation. Hemodynamic Consequences Depolarization & ECG Atrial Fibrillation How to make ORDER out of CHAOS Julia Shih, VMD, DACVIM (Cardiology) October 27, 2018 Depolarization & ECG Depolarization & ECG Atrial Fibrillation Hemodynamic Consequences

More information

In Whom and When Should Atrial Fibrillation Ablation be Considered?

In Whom and When Should Atrial Fibrillation Ablation be Considered? In Whom and When Should Atrial Fibrillation Ablation be Considered? Christian de Chillou, MD, PhD Department of Cardiology University Hospital Nancy, France ESC 2010 Stockholm, August 30. 2010 2 In Whom?

More information

CVD: Cardiac Arrhythmias. 1. Final Cardiac Arrhythmias_BMP. 1.1 Cardiovascular Disease. Notes:

CVD: Cardiac Arrhythmias. 1. Final Cardiac Arrhythmias_BMP. 1.1 Cardiovascular Disease. Notes: CVD: Cardiac Arrhythmias 1. Final Cardiac Arrhythmias_BMP 1.1 Cardiovascular Disease 1.2 Directions for taking this course 1.3 Content Experts 1.4 Disclosures 1.5 Accreditation Information 1.6 Learning

More information

Innovations in AF Management

Innovations 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 information

AF in the ER: Common Scenarios CASE 1. Fast facts. Diagnosis. Management

AF in the ER: Common Scenarios CASE 1. Fast facts. Diagnosis. Management AF in the ER: Common Scenarios Atrial fibrillation is a common problem with a wide spectrum of presentations. Below are five common emergency room scenarios and the management strategies for each. Evan

More information

Review guidance for patients on long-term amiodarone treatment

Review guidance for patients on long-term amiodarone treatment Review guidance for patients on long-term amiodarone treatment This review guidance document has been produced in response to: 1. Current supply shortages of branded and generic versions of 100mg and 200mg

More information

Catheter Ablation: Atrial fibrillation (AF) is the most common. Another Option for AF FAQ. Who performs ablation for treatment of AF?

Catheter Ablation: Atrial fibrillation (AF) is the most common. Another Option for AF FAQ. Who performs ablation for treatment of AF? : Another Option for AF Atrial fibrillation (AF) is a highly common cardiac arrhythmia and a major risk factor for stroke. In this article, Dr. Khan and Dr. Skanes detail how catheter ablation significantly

More information

ATRIAL FIBRILLATION: REVISITING CONTROVERSIES IN AN ERA OF INNOVATION

ATRIAL 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 information

APPROACH TO TACHYARRYTHMIAS

APPROACH TO TACHYARRYTHMIAS APPROACH TO TACHYARRYTHMIAS PROF.DR.MD.ZAKIR HOSSAIN PROFESSOR AND HEAD DEPARTMENT OF MEDICINE SZMCH TACHYARRYTHMIA Cardiac arrythmia is a disturbance of electrical rhythm of heart. Cardac arrythmia with

More information

Mission Statement for our Arrhythmia Care

Mission Statement for our Arrhythmia Care Mission Statement for our Arrhythmia Care We are dedicated to provide a compassionate and an outstanding care for patients with cardiac arrhythmias. We will be utilizing the cutting edge and the most advanced

More information

Scompenso cardiaco e F A : ruolo della ablazione transcatetere. Prof. Fiorenzo Gaita

Scompenso cardiaco e F A : ruolo della ablazione transcatetere. Prof. Fiorenzo Gaita Scompenso cardiaco e F A : ruolo della ablazione transcatetere Prof. Fiorenzo Gaita Patients with atrial fibrillation (%) Prevalence of AF in HF Trials 60 50 30% NYHA III-IV NYHA IV 40 NYHA II-III 30 20

More information

Management of atrial fibrillation a holistic view - Prof. Dr. Martin Borggrefe Mannheim

Management of atrial fibrillation a holistic view - Prof. Dr. Martin Borggrefe Mannheim a holistic view - Prof. Dr. Martin Borggrefe Mannheim Patients with atrial fibrillation (millions) 16 14 12 10 8 6 4 2 0 Management of atrial fibrillation Expected prevalence of apparent AF 5,1 5,1 5,9

More information

Cardiac Arrhythmias. Cathy Percival, RN, FALU, FLMI VP, Medical Director AIG Life and Retirement Company

Cardiac Arrhythmias. Cathy Percival, RN, FALU, FLMI VP, Medical Director AIG Life and Retirement Company Cardiac Arrhythmias Cathy Percival, RN, FALU, FLMI VP, Medical Director AIG Life and Retirement Company The Cardiovascular System Three primary functions Transport of oxygen, nutrients, and hormones to

More information

Interesting EP Cases Catheter ablation to treat congestive heart failure (CHF)

Interesting EP Cases Catheter ablation to treat congestive heart failure (CHF) Interesting EP Cases Catheter ablation to treat congestive heart failure (CHF) Yiming WU, MD, PhD. Alaska heart and vascular institute. ywu@alaskaheart.com 907-561-3211 19 yo man transferred for out side

More information

Contemporary Strategies for Catheter Ablation of Atrial Fibrillation

Contemporary Strategies for Catheter Ablation of Atrial Fibrillation Contemporary Strategies for Catheter Ablation of Atrial Fibrillation Suneet Mittal, MD Director, Electrophysiology Medical Director, Snyder Center for Atrial Fibrillation The Arrhythmia Institute at The

More information

Ventricular tachycardia and ischemia. Martin Jan Schalij Department of Cardiology Leiden University Medical Center

Ventricular tachycardia and ischemia. Martin Jan Schalij Department of Cardiology Leiden University Medical Center Ventricular tachycardia and ischemia Martin Jan Schalij Department of Cardiology Leiden University Medical Center Disclosure: Research grants from: Boston Scientific Medtronic Biotronik Sudden Cardiac

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

ΚΟΛΠΙΚΗ ΜΑΡΜΑΡΥΓΗ ΦΑΡΜΑΚΕΥΤΙΚΗ ΗΛΕΚΤΡΙΚΗ ΑΝΑΤΑΞΗ. ΣΠΥΡΟΜΗΤΡΟΣ ΓΕΩΡΓΙΟΣ Καρδιολόγος, Ε/Α, Γ.Ν.Κατερίνης. F.E.S.C

ΚΟΛΠΙΚΗ ΜΑΡΜΑΡΥΓΗ ΦΑΡΜΑΚΕΥΤΙΚΗ ΗΛΕΚΤΡΙΚΗ ΑΝΑΤΑΞΗ. ΣΠΥΡΟΜΗΤΡΟΣ ΓΕΩΡΓΙΟΣ Καρδιολόγος, Ε/Α, Γ.Ν.Κατερίνης. F.E.S.C ΚΟΛΠΙΚΗ ΜΑΡΜΑΡΥΓΗ ΦΑΡΜΑΚΕΥΤΙΚΗ ΗΛΕΚΤΡΙΚΗ ΑΝΑΤΑΞΗ ΣΠΥΡΟΜΗΤΡΟΣ ΓΕΩΡΓΙΟΣ Καρδιολόγος, Ε/Α, Γ.Ν.Κατερίνης. F.E.S.C Definitions of AF: A Simplified Scheme Term Definition Paroxysmal AF AF that terminates

More information