Atrial Fibrillation

Introduction

Stroke
AF
Heart
Failure
Sudden
Death
Cardiovascul
ar Morbidity
 Incidence and prevalence of atrial
fibrillation
In 2010, the estimated numbers of men and
women with AF worldwide were 20.9 million and
12.6 million.
AF prevalence in older persons and in patients with
conditions such as hypertension, heart failure, coronary
artery disease (CAD), valvular heart disease, obesity,
diabetes mellitus, and chronic kidney disease (CKD).
Pathophysiologi
Detection and management of risk factors and
concomitant cardiovascular diseases

Heart failure
Hypertension
Valvular heart disease
Diabetes mellitus
Obesity and weight loss
Chronic obstructive pulmonary disease, sleep apnoea,
and other
respiratory diseases
Chronic kidney disease
Heart Failure
Hypertension
Hypertension is a stroke risk factor in AF, uncontrolled
high bloodnpressure enhances the risk of stroke and
bleeding events and may lead to recurrent AF.
Inhibition of the reninangiotensinaldosterone system
can prevent structural remodelling and recurrent AF.

ACE inhibitors or
ARBs
Valvular Heart Disease
Approximately 30% of patients with AF have some form
of valvular heart disease.
Patients with mitral valve stenosis and other valvular
diseases, including mitral regurgitation or aortic valve
disease, need to be considered when choosing an
anticoagulant or indeed to estimate stroke risk in AF.
Diabetes Mellitus
Diabetes is a risk factor for stroke and other
complications in AF.
Treatment with metformin seems to be associated with
a decreased long-term risk of AF in diabetic patients and
may even be associated with a lower long-term stroke
risk.
Obesity and Weight Loss
Obesity may also be a risk factor for ischaemic stroke,
thrombo-embolism, and death in AF patients.
Obese patients may have more LV diastolic dysfunction,
increased sympathetic activity and inflammation, and
increased fatty infiltration of the atria.
Intensive weight reduction is management for obese
patients in AF.
 Chronic Obstructive Pulmonary Disease, Sleep
Apnoea, and Other Respiratory Diseases

Multiple pathophysiological mechanisms can contribute

to AF in obstructive sleep apnoea, including autonomic
dysfunction, hypoxia, hypercapnia, and inflammation.
Agents used to relieve bronchospasm, theophyllines and
beta-adrenergic agonists, may precipitate AF.
Non-selective beta-blockers, sotalol, propafenone, and
adenosine should be used with caution in patients with
significant bronchospasm, but they can safely be used
in patients with chronic obstructive pulmonary disease.
Chronic Kidney Disease
AF is present in 1520% of patients with CKD.
Estimated creatinine clearance (CrCl) rate of < 60
mL/min is indicative of CKD.
Anticoagulation can be safely used in AF patients with
moderate or moderate-to-severe CKD [glomerular
filtration rate (GFR) 15 mL/min] reported good
outcomes on warfarin (INR 23).
 Integrated Management of
Patients with Ttrial Fibrillation
Stroke Prevention in Atrial
Fibrillation
Stroke Prevention in Atrial
Fibrillation
Rate or Rhythm Control
Management
 Recommendations for Rate
Control of AF
Beta-blockers, digoxin, diltiazem, or verapamil are
recommended to control heart rate in AF patients with
LVEF 40% (Class IB).

Beta-blockers and/or digoxin are recommended to

control heart rate in AF patients with LVEF <40% (Class
IB).
Rhythm Control Management of Recent Onset
Atrial Fibrillation
Initiation of Long Term Rhythm Control Therapy
in Symptomatic Patients With Atrial Fibrillation
TERIMA KASIH