Diagnosisof atrial fibrillation
Definitionof atrial fibrillation
A supraventricular tachyarrhythmia with uncoordinated atrialelectrical activation and consequently ineffective atrialcontraction.
• Irregularly irregular R-R intervals (when atrioventricularconduction is not impaired), • Absence of distinct repeating Pwaves,and
Symptomatic or asymptomatic AF that is documented bysurfaceECG.
TheminimumdurationofanECGtracingofAFrequiredto establish the diagnosis of clinical AF is at least 30 seconds, orentire12-lead ECG
Diagnosticcriteria foratrial fibrillation
The diagnosis of AF is based on an ECG tracing heart rhythm with nodiscerniblerepeatingPwavesandirregularR-Rintervals.ECGtracingof≥30secondsis diagnosticof clinicalAF [4](Class IB).
Classificationof AF
Firstdiagnosed AFnotdiagnosedbefore,irrespectiveofitsdurationor thepresence/severityofAF-relatedsymptoms.
Persistent AF that is continuously sustained beyond 7 days,includingepisodesterminatedbycardioversion(drugsor electricalcardioversion)after>_7days
Permanent AF that is accepted by the patient and physician, and nofurther attempts to restore/maintain sinus rhythm will beundertaken Permanent AF represents a therapeuticattitude of the patient and physician rather than aninherent pathophysiological attribute of AF, and the termshould not be used in the context of a rhythm controlstrategywith antiarrhythmicdrug therapy or AF ablation Should a rhythm control strategybeadopted,thearrhythmiawouldbereclassifiedas
Atrialfibrillation management
ACBpathway
AccordingtoESCAFguideline2020,thesimpleAtrialfibrillationBetterCare(AB C) wasrecommended forAF management.
B: Better symptom control (choose rhythm control or rate controlstrategy)
Indicationsforatrialfibrillationcatheterablation
Table 1.3: HRS/EHRA/ECAS/APHRS/SOLAECE indications for catheterablation [5]
AFrefractory or intoleranttoatleastoneCl assIorIII antiarrhythmicmedication
Symptomatic AF priorto initiation ofantiarrhythmic therapywith a Class I or
In2020,theEuropeanSocietyofCardiologyissuednewguidelinesontheindication for catheter ablation of AF These guidelines recommend persistentAF ablation in symptomatic patients with low risk of recurrence and failure ofmedicaltherapy asa classI recommendation[3].
Recentstudiesaboutatrialfibrillationcatheterablation
OverviewofstudyaboutatrialfibrillationinVietnam
- Tuan N.X (2013) reported arrhythmias after cardiac surgery at HanoiHeart Hospital: the highest rate of AF after coronary surgery, accounting for56.25%,aftersurgery,valvularheartdiseasewas20.9%,whileaftercongenitalheartsurge ry this rateis only 9.52%[6]
- ToanN.D,OanhN.OandHieuN.L(2015)conductedastudytoinvestigate the rate of
AF in patients with heart failure and recorded the resultup to 27.2% (in 213 patients), this rate tends to be higher in the group of patientswithreducedleftventricularfunction