Behandlungsoptionen bei Patienten mit Vorhofflimmern auf Intensivstation

Arash Arya

European Heart Journal (2016) 37, 2893–2962

Aim of acute management:

Überblick: RACE Protocol

Herzog et al. Critical Pathways in Cardiology • Volume 16, Number 2, June 2017

RACE à R: Rate ManagementIn about 60% to 70% of patients with AF, a rapidventricular rate is observed, and symptoms areusually present depending on the rapidity of theventricular response, the length of time thearrhythmia is sustained, and the presence and typeof underlying heart disease.

RateManagement

HF/LVEF<40%

LVEF ≥ 40%

BB* à AM/DG à CV

BB/CHB à DG à CV

* Low-Dose Beta-Blocker

European Heart Journal (2016) 37, 2893–2962

OAC

RACE à A: Anticoagulation

European Heart Journal (2016) 37, 2893–2962

Curr Probl Cardiol. 2019 Feb 27. pii: S0146-2806(19)30019-2.

EP Europace, Volume 20, Issue 1, January 2018, Pages 1–11

Europace (2019) 21, 192–217

NEJM 2019: DOI: 10.1056/NEJMoa1900353

…hemodynamically stable, recent-onset (<36hours), symptomatic atrial fibrillation in theemergency department to be treated with a wait-and-see approach (delayed-cardioversion group)or early cardioversion.

Among the patients who completed remote monitoringduring 4 weeks of follow-up, a recurrence of atrialfibrillation occurred in 49 of 164 patients (30%) in thedelayed-cardioversion group and in 50 of 171 (29%) inthe early cardioversion group.

European Heart Journal (2016) 37, 2893–2962

European Heart Journal (2016) 37, 2893–2962

The need of proper anticoagulation for cardio-version ofatrial fibrillation (AF) episodes with duration≥ 48 h is wellestablished. Nonanticoagulated patients carry a risk forthrombo-embolism of up to 10%.

JACC Clin Electrophysiol. 2016;2:487-494.JACC Clin Electrophysiol. 2016;2:495-497.

… However, no events occurred in postoperative patients and inthose with CHA2DS2-VASc scores of <2 (0, 1), supporting theutility of accurate assessment of AF onset and risk stratificationin determining the need for anticoagulation for cardioversion ofAF <48 h in duration. Europace (2015) 17, 18–23

Arrhythmia & Electrophysiology Review 2017;6(2):50–4.

CV

Cardiol Clin. 2018 Feb;36(1):141-159.

EP

European Heart Journal (2016) 37, 2893–2962

Vielen Dank!