abri DEMIRCN Istanbul Bilim University Department of Cardiology
H/CC/HR Guideline for the Management of Patients With trial Fibrillation. J m Coll Cardiol 4;64:46-8.
European Heart Journal () 3, 369-49
Nattel, et al. J m Coll Cardiol 4;63:335 45
Electrical F (trigger dependent F Electroanatomic F (trigger and substrat dependent F) natomical F (substrat dependent, role of trigger is less) Mahnkopf C, et al: Evaluation of the left atrial substrate in patients with lone atrial fibrillation using delayed-enhanced MRI: Implications for disease progression and response to catheter ablation, Heart Rhythm 7:475 48,
European Heart Journal () 3, 369-49
European Heart Journal () 3, 369-49
EHR Class Explanation EHR I No symptoms EHR II Mild symptoms ; normal daily activity not affected EHR III evere symptoms ; normal daily activity affected EHR I Disabling symptoms ; normal daily activity discontinued European Heart Journal () 3, 369-49 9
Outcome Death troke (includes haemorrhagic stroke and cerebral bleeds) Hospitalizations Quality of life and exercise capacity Left ventricular function Relative Change in F patients Death rate doubled troke risk increased; F is associated with more severe stroke Hospitalizations are frequent in F patients and may contribute to reduced quality of life Wide variation, from no effect to major reduction. F can cause marked distress through palpitations and other F-related symptoms Wide variation, from no change to tachycardiomyopathy with acute heart failure European Heart Journal () 3, 369-49
ymptoms troke prevention Decreasing of hospitalizations Improvement of quality of life and exercise capacity urvive
6 y, male Palpitation despite of amiodarone and sotatol No syncope No history of known heart disease Family history: CD - Normal physical examination
Echocardiography: L dilatation and dysfunction Holter recording: Multiple short episodes of wide and narrow QR tachycardia Failed T ablation (T not inducible) Cardiac MR diagnosis: Non-compaction Recommendation: ICD
fter 4 months; No palpitation and any arrhythmia (Holter) Echocardiography; LEDD : 6 mm (57 mm) LED : 47 mm (4 mm) LEF : 47 % (5 %) L diam : 47 mm (4 mm) PP : 4 mmhg (7 mmhg)
64 y, male patient Dyspnea 3 hospitalizations and cardioversion because of decompensation related with persistent F after CRT upgrade in year History; 998 MI, multiple PCI - DDD-ICD implantation (paroxysmal F,, node disease, systolic dysfunction and inducible T) CRT-D upgrade (Heart failure, continue P, severe MR) Improvement in EF and clinical status after upgrade
Treatment; Ramipril 5 mg Metoprolol x 5 mg pironolacton 5 mg Warfarin torvastatin Furosemide D Treatment; Long term amiodarone (hypothyrodism) otalol Propafenone
Echocardiography; EF: 4-45 % (54/43 mm) Left atrium diameter: 4 mm PP: 35 mmhg (+) MR
9995 oftware ersion 7.3 Copyright Medtronic, Inc. 6 7-Feb- 6:3:6 Pa T B T D T D T D T D B T D T D T D T D B T D T D T D 4 4 4 4 4 Waveform suspended for 5 min 6 9 8 T D T D B T D T D T D P B T D T D P B T D P B T D T D B R R R R B R R R 3 9 4 6 5 8 9 3 4 4 6 3 5 4 6 8 5 R B R R B b R R C E R B C D P P B P B 4 5 3 4 5 5 3 3 3 8 8 4 37
4 Jan Mar May Jul ep Nov Jan Heart rate variability (ms) > 6 8 <4 Jan Mar May Jul ep Nov Jan 9995 oftware ersion 7.3 Cardiac Compass Rep Copyright Medtronic, Inc. 6 Page Printed: 7-Feb- 6:
max/day avg/day 5 <5 % Pacing/day trial entricular 75 5 5 vg. rate (bpm) Day Night > 8 6 <4 Patient activity hours/day 4 3 Jan Mar May Jul ep Nov Jan 9995 oftware ersion 7.3 Cardiac Compass R Copyright Medtronic, Inc. 6 Page Printed: 7-Feb- 6:
European Heart Journal () 3, 369-49
Testa L et al, European Heart Journal 5; 6: 6
European Heart Journal ; 33:79-747
H/CC/HR Guideline for the Management of Patients With trial Fibrillation. J m Coll Cardiol 4;64:46-8.
H/CC/HR Guideline for the Management of Patients With trial Fibrillation. J m Coll Cardiol 4;64:46-8.