7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF...
Transcript of 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF...
![Page 1: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/1.jpg)
FIBRILLAZIONE ATRIALE
Mauro Zennaro
FIBRILLAZIONE ATRIALE
Mauro Zennaro
![Page 2: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/2.jpg)
GIANNI
67
• Ipertensione arteriosa
• Sovrappeso
2014
EPISODI RECIDIVANTI DI CARDIOPALMO
GIANNI
67 aa
Ipertensione arteriosa
Sovrappeso
2014 intervento di chirurgia bariatrica
EPISODI RECIDIVANTI DI CARDIOPALMO
![Page 3: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/3.jpg)
Recommendations for diagnostic workup of Recommendations for diagnostic workup of atrial fibrillation patients
![Page 4: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/4.jpg)
![Page 5: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/5.jpg)
![Page 6: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/6.jpg)
………FRANCO…….IL COGNATO DEL PAZIENTE (CHE NON PRESENTA SINTOMI)………FRANCO…….IL COGNATO DEL PAZIENTE (CHE NON PRESENTA SINTOMI)
![Page 7: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/7.jpg)
ESC Guidelines 2016
![Page 8: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/8.jpg)
0
50
miocardiopatia
miscellanea
c.ischemica
c.ipertensiva
c.valvolare
"lone"
FA parossistica FA persistente
CammCamm
0
50
FA persistente
Camm & Obel - Am J Cardiol 1996; 78: 3-11Camm & Obel - Am J Cardiol 1996; 78: 3-11
![Page 9: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/9.jpg)
Come si presenta
![Page 10: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/10.jpg)
irregolarità RR
perdita contributo atriale
tachicardia
(cardiomiopatia)
insufficienza
mitralica
portata
insufficienza
mitralica
![Page 11: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/11.jpg)
MOTIVI PER CARDIOLOGICA VALUTAZIONE URGENTE
![Page 12: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/12.jpg)
Cosa fare.
• A 12-lead ECG is recommended to establish a
determine rate in AF, and to screen for conduction
structural heart disease.
• Initial blood tests should evaluate thyroid and kidney function,
electrolytes and full blood count.
• Transthoracic echocardiography should be used to
valvular disease) and assess LV size and function
and right heart function.
GIANNI
-Ventricolo sx non dilatato.
-EF normale
-Atrio sx ai limiti alti della norma
-Non IM
FRANCO
-
-
-
-
lead ECG is recommended to establish a suspected diagnosis of AF, to
for conduction defects, ischaemia, and signs of
Initial blood tests should evaluate thyroid and kidney function, as well as serum
echocardiography should be used to identify structural disease (e.g.
and function (systolic and diastolic), atrial size,
FRANCO
Ventricolo sx non dilatato.
EF 50%
Atrio sx moderatamente dilatato
IM moderata
![Page 13: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/13.jpg)
Rate or rhythm control
The acute management of patients with AF is driven by
embolic events and acute improvement
The severity of AF-related symptoms should drive the decision for acute restoration of sinus
rhythm (in severely compromised patients) or acute management
of the ventricular rate (in most other patients).
control
The acute management of patients with AF is driven by acute protection against thrombo-
embolic events and acute improvement of cardiac function.
decision for acute restoration of sinus
patients) or acute management
(in most other patients).
![Page 14: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/14.jpg)
Rate or
Rhythm control
![Page 15: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/15.jpg)
Canadian CardioVascular Society – Atrial Fibrillation Guidelines
rate and rhythm management
Atrial Fibrillation Guidelines 2010:
![Page 16: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/16.jpg)
![Page 17: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/17.jpg)
![Page 18: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/18.jpg)
Efficacia e Tollerabilità
28
50 52 54
5
3538
15
0
25
50
75
100
Plac Quin Disop Propa
Sinus Rhythm Adverse Events
Efficacia e Tollerabilità
59
50
73
15 17
36
28
Propa Fleca Sotal Amio
Adverse Events
![Page 19: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/19.jpg)
Farmaco Metabolismo; dose Tossicità non cardiovascolare Tossicità
Modificato da Zimetbaum P. Circulation
cardiovascolare Tossicità cardiovascolare
2012;125:381-9.
![Page 20: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/20.jpg)
![Page 21: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/21.jpg)
The recommendations of the ACC/AHA/HRS, CCS, and ESC are in general
each providing a strong recommendation for AF ablation
an AAD has failed (strong recommendation for CCS
Canadian Journal of Cardiology
Review
Contemporary Atrial Fibrillation Management: A of the Current AHA/ACC/HRS, CCS, and ESC
Jason G. Andrade, MD,a,b Laurent Macle
Atul Verma, MD,c and John Cairns, MD
of the ACC/AHA/HRS, CCS, and ESC are in general agreement, with
ablation for paroxysmal AF patients in whom
for CCS, grade I for ESC, and ACCF/AHA/HRS).
Cardiology 33 (2017) 965e976
Review
Management: A ComparisonAHA/ACC/HRS, CCS, and ESC Guidelines
Macle, MD,b Stanley Nattel, MD,b
and John Cairns, MD
![Page 22: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/22.jpg)
![Page 23: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/23.jpg)
Rate control therapy
![Page 24: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/24.jpg)
![Page 25: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/25.jpg)
![Page 26: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/26.jpg)
LA TERAPIA ANTICOAGULANTE
La scelta difficile
![Page 27: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/27.jpg)
comparative efficacy of high-dose of NOACS and warfarin
significantly reduced the composite of stroke or systemic
Comparison of the efficacy and safety of new oral anticoagulants
with warfarin in patients with atrial fibrillation: a meta-analysis of
randomised trials
42 411 participants received a new oral anticoagulant and
29 272 participants received warfarin
warfarin. Allocation to a new oral anticoagulant
embolic events by 19% compared with warfarin
C.T Ruff Dr Lancet, The, 2014-03-15
Comparison of the efficacy and safety of new oral anticoagulants
analysis of
42 411 participants received a new oral anticoagulant and
![Page 28: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/28.jpg)
The benefit was mainly driven by a large reduction in haemorrhagic
New oral anticoagulants were also associated with a significant reduction in all
The drugs were similar to warfarin in the prevention of ischaemic
C.T
haemorrhagic stroke.
oral anticoagulants were also associated with a significant reduction in all-cause mortality
ischaemic stroke and myocardial infarction
C.T Ruff Dr Lancet, The, 2014-03-15
![Page 29: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/29.jpg)
Growing body of real-world experience from >650 000 patients
Clinical practice (n>650 000 patients
world experience from >650 000 patients
000 patients)
![Page 30: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/30.jpg)
INDICATION FOR USE OF THE ANTIDOTES
![Page 31: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/31.jpg)
Nel mondo reale
Considerare il dosaggio adeguato al paziente e le interferenze farmacologiche
Gli studi di fase 3 possono essere tra loro non confrontabili.
Studi 1:1 confronto diretto.
Considerare il dosaggio adeguato al paziente e le interferenze farmacologiche
![Page 32: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/32.jpg)
European Heart Journal Supplements (2017) 19 Supplement D
EHRA/EAPCI44
![Page 33: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/33.jpg)
![Page 34: 7 aprile Fibrillazione atriale - Ordine dei Medici ... · The acute management of patients with AF is driven by embolic events and acute improvement The severity of AF-related symptoms](https://reader033.fdocuments.in/reader033/viewer/2022042320/5f0a29157e708231d42a4db4/html5/thumbnails/34.jpg)
Grazie per l’attenzione Grazie per l’attenzione