European Heart Journal (2006):27, 1979-2030 Joint ESC/ACC/AHA Guidelines 2006 Developed in collaboration with the European Heart Rhythm Association (EHRA)

European Heart Journal (2006):27, 1979-2European Heart Journal (2006):27, 1979-2030030

Joint ESC/ACC/AHA Guidelines 2006Joint ESC/ACC/AHA Guidelines 2006

Developed in collaboration with the Developed in collaboration with the European Heart Rhythm Association European Heart Rhythm Association

(EHRA) and the Heart Rhythm Society (EHRA) and the Heart Rhythm Society (HRS)(HRS)

Atrial Fibrillation Atrial Fibrillation (Management of Patients (Management of Patients

with)with)

Joint ESC/ACC/AHA Guidelines Joint ESC/ACC/AHA Guidelines

Supraventricular tachyarrhythmia characterized Supraventricular tachyarrhythmia characterized by uncoordinated atrial activation with by uncoordinated atrial activation with consequent deterioration of mechanical functionconsequent deterioration of mechanical function

Most common sustained cardiac rhythm Most common sustained cardiac rhythm disturbancedisturbance– 2.3 mill. N.America, 4.5 mill EU: parox AF/ persist AF2.3 mill. N.America, 4.5 mill EU: parox AF/ persist AF

Prevalence increases with agePrevalence increases with age Often associated with structural heart diseaseOften associated with structural heart disease Acute temp causes: Acute temp causes: etoh, hyperthyr, surgery, etoh, hyperthyr, surgery,

peri-/myocarditis, MI, PE, pulm.dis, metabolic,…peri-/myocarditis, MI, PE, pulm.dis, metabolic,…

Haemodynamic impairment and Haemodynamic impairment and thromboembolic events result in significant thromboembolic events result in significant morbidity, mortality, cost morbidity, mortality, cost

Atrial Fibrillation Atrial Fibrillation

Joint ESC/ACC/AHA Guidelines Joint ESC/ACC/AHA Guidelines

Patterns of Atrial Patterns of Atrial Fibrillation Fibrillation

Joint ESC/ACC/AHA Guidelines Joint ESC/ACC/AHA Guidelines

Management Management strategies strategies

Rate controlRate control– no commitment to restore or maintain SRno commitment to restore or maintain SR– beta bl., diltiazem, verapamil; HF: digox; acc.pw: amiodarbeta bl., diltiazem, verapamil; HF: digox; acc.pw: amiodar

Prevention of thromboembolismPrevention of thromboembolism– antithrombotic therapy recommended to all AF, exc.lone antithrombotic therapy recommended to all AF, exc.lone

AF or CIAF or CI– agent based upon risk of stroke/bleeding agent based upon risk of stroke/bleeding

Correction of rhythm disturbance (?)Correction of rhythm disturbance (?)– restoration and/or maintenance of sinus rhythmrestoration and/or maintenance of sinus rhythm– also requires attention to rate control also requires attention to rate control

Joint ESC/ACC/AHA Guidelines Joint ESC/ACC/AHA Guidelines

Prevention of Prevention of thromboembolismthromboembolism

Joint ESC/ACC/AHA Guidelines Joint ESC/ACC/AHA Guidelines

Cardioversion of AF: Cardioversion of AF: recommendations recommendations

AF + rapid VR + HD-instability: AF + rapid VR + HD-instability: DC-cardioversionDC-cardioversion AF + rapid VR + angina, HT, HF + no prompt response to AF + rapid VR + angina, HT, HF + no prompt response to

pharm. Measures: pharm. Measures: DC-cardioversionDC-cardioversion

rhythm control rhythm control ((pharmacological and DC-cardioversionpharmacological and DC-cardioversion !): !): – < 48h duration, anticoagulation before/after according risk< 48h duration, anticoagulation before/after according risk– > 48h/unknown duration: > 48h/unknown duration:

antico antico 3w prior to and 4w after3w prior to and 4w after TOE: no thrombus, antico during and 4w afterTOE: no thrombus, antico during and 4w after consider AAD-pretreatment (if safe!)consider AAD-pretreatment (if safe!)

Interruption of antico for procedures:Interruption of antico for procedures:– antico may be interrupted for up to 1 wk without heparin-subst antico may be interrupted for up to 1 wk without heparin-subst – mechanical prosthetic valves + prior stroke/TIA: (lmw)heparin mechanical prosthetic valves + prior stroke/TIA: (lmw)heparin

substsubst