File AFVietnam

Treatment Goals and Strategies Rate control Pharmacologic • • • • Ca2+ blockers -blockers Digitalis Amiodarone Nonpharmacologic • Ablate and pace Prevent Remodeling Maintenance of SR Pharmacologic Stroke prevention Nonpharmacologic Pharmacologic Class IA Class IC Class III -blocker Catheter ablation Pacing Surgery Implantable devices • Warfarin • Aspirin • Thrombin Inhibitor Nonpharmacologic • Removal/isolation LA appendage CCB ACE-I, ARB Statins Fish oil Rationale for maintaining sinus rhythm Less symptoms Discontinue coumadin Better survival Mortality From AA Rx in AF 77% 1A 21% 1C 2% Amio Flaker, et al SPAF, JACC 1992 Rate control in AFFIRM < 80/min at rest < 110/min minute walk 80% achieved rate control and 35% were in sinus at year visit Anticoagulation therapy AFFIRM Required for all in rate control group Discontinued at MD discretion if sinus rhythm maintained for at least consecutive weeks Appendage occlusion LA Appendage occluder ESC guidelines 2010 ESC guidelines 2010 conclusion Important advances in pharmacologic/non-pharmacologic treatment of AF as well as novel Anticoagulation options