8 fibrillazione atriale - ordine dei medici chirurghi e ...€¦ · 8 fibrillazione atriale author:...
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FIBRILLAZIONE ATRIALE
Mauro Zennaro
FIBRILLAZIONE ATRIALE
Mauro Zennaro
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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
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Recommendations for diagnostic workup of Recommendations for diagnostic workup of atrial fibrillation patients
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………FRANCO…….IL COGNATO DEL PAZIENTE (CHE NON PRESENTA SINTOMI)………FRANCO…….IL COGNATO DEL PAZIENTE (CHE NON PRESENTA SINTOMI)
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ESC Guidelines 2016
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50
miocardiopatiamiscellaneac.ischemicac.ipertensivac.valvolare"lone"
0
"lone"
FA parossistica FA persistente
CammCamm
50
0
FA persistente
Camm & Obel - Am J Cardiol 1996; 78: 3-11Camm & Obel - Am J Cardiol 1996; 78: 3-11
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Come si presenta
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perdita contributo atriale
tachicardia
(cardiomiopatia)
irregolarità RR
insufficienza
mitralica
portata
insufficienza
mitralica
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MOTIVI PER CARDIOLOGICA VALUTAZIONE URGENTE
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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 • 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. 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
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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).
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Rate or
Rhythm controlRhythm control
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Canadian CardioVascular Society – Atrial Fibrillation Guidelines
rate and rhythm management
Atrial Fibrillation Guidelines 2010:
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Efficacia e Tollerabilità
50 52 54
3538
50
75
100
Sinus Rhythm Adverse Events
28
5
35
15
0
25
Plac Quin Disop Propa
Efficacia e Tollerabilità
59
50
73
36
Adverse Events
15 17
36
28
Propa Fleca Sotal Amio
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Farmaco Metabolismo; dose Tossicità non cardiovascolare Tossicità
Modificato da Zimetbaum P. Circulation
cardiovascolare Tossicità cardiovascolare
2012;125:381-9.
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The recommendations of the ACC/AHA/HRS, CCS, and ESC are in general each providing a strong recommendation for AF ablation
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
each providing a strong recommendation for AF ablationan AAD has failed (strong recommendation for CCS
of the ACC/AHA/HRS, CCS, and ESC are in general agreement, with ablation for paroxysmal AF patients in whom
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
ablation for paroxysmal AF patients in whomfor CCS, grade I for ESC, and ACCF/AHA/HRS).
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Rate control therapyRate control therapy
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LA TERAPIA ANTICOAGULANTE
La scelta difficile
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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
Comparison of the efficacy and safety of new oral anticoagulants
analysis of
42 411 participants received a new oral anticoagulant and
C.T Ruff Dr Lancet, The, 2014-03-15
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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
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Growing body of real-world experience from >650 000 patients
Clinical practice (n>650000 patients
world experience from >650 000 patients
000 patients)
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INDICATION FOR USE OF THE ANTIDOTES
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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
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European Heart Journal Supplements (2017) 19 Supplement D
EHRA/EAPCI44
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Grazie per l’attenzione Grazie per l’attenzione