Hội Tim mạch học Việt Nam AF HF Mx talk

63 140 0
Hội Tim mạch học Việt Nam AF HF Mx talk

Đang tải... (xem toàn văn)

Tài liệu hạn chế xem trước, để xem đầy đủ mời bạn chọn Tải xuống

Thông tin tài liệu

Hội Tim mạch học Việt Nam AF HF Mx talk tài liệu, giáo án, bài giảng , luận văn, luận án, đồ án, bài tập lớn về tất cả c...

Atrial Fibrillation Management in Heart Failure patients Dr Teo Wee Siong MBBS (S’pore), M Med (Int Med), FAMS, MRCP (UK), FRCP (Edin), FACC, FHRS Director of Electrophysiology and Pacing National Heart Centre Singapore Mt Elizabeth Hospital Singapore Management depends on:  Clinical presentation of AF     New onset, paroxysmal , persistent, long standing persistent, permanent or unknown Severity of heart failure esp NYHA Class IV Underlying heart disease Severity of atrial dilatation Treatment of AF in HF   Rate vs Rhythm control Specific therapies  Drugs Antiarrhythmic drugs  Drugs for HF /substrate modification  Devices – pacemakers, Atrial defibrillators, ICDs, CRT  Ablation – AV node ablation, AF ablation   Prevention of AF Upstream therapy - ACE inhibitors, ARB, Statins  Devices – atrial pacing, minimal ventricular pacing  Rate vs Rhythm control for AF in HF pts     AF in HF is a/w higher mortality Does conversion to sinus rhythm improve survival Use of antiarrhythmic drugs may worsen outcome ?Role of new drugs for AF and HF AF in HF is a/w increased mortality Maintenance of sinus rhythm improved survival ? AF-CHF Study - Rhythm Control versus Rate Control for Atrial Fibrillation and Heart Failure Kaplan-Meier Estimates of Death from Cardiovascular Causes (Primary Outcome) In pts with AF and congestive heart failure, a routine strategy of rhythm control does not reduce the rate of death from cardiovascular causes, as compared with a rate-control strategy Roy D et al N Engl J Med 2008;358:2667-2677 Spontaneous conversion to SR after CRT  Spontaneous sinus rhythm resumption has been reported in CRT pts Kies, Leclercq Heart 2006;92:490-4  Saxon L Cardiovasc Electrophysiol 2006;17:520-5  CRT- AF to sinus    TKC Cardiac Failure NYHA Class III-IV Persistent AF Management of AF in CRT pts  AF which is rapid in the HF pt with CRT results in: Loss of AV synchrony  Reduce biventricular pacing   May require AV node ablation to optimize biV pacing Consistent biV capture – eliminated fusion  Eliminates risk of uncontrolled ventricular rate  Regularizes the ventricular rate  Possible discontinuation of drugs which can further impair LV function negatively affecting morbitidy and mortalithy  CRT pts who develop AF – AVN ablation may be needed Role of Ablation   Ablate and pace (with CRT) Ablation of AF AVN ablation for rapid AV and HF  Advantage         Quick and usually easy to ablate AV node 99% long term efficacy No more need for rate control drugs Improves symptoms and QOL Increase in functional capacity Improvement in LVEF Decrease utilization of healthcare resources Disadvantage    Requires EP expertise Requires life long pacing Preferably needs CRT in pts with preexisting HF Catheter Ablation of AF  Techniques – Ablation of SVT (AT, AVNRT, WPW) degenerating to AF – Isolation of focal AF (PV, SVC, CS os) – Linear Ablation in RA + LA  Indications – – – – Young pts with highly symptomatic AF “Focal” AF – frequent nonsustain AT Drug refractory No severe heart disease AF Ablation in HF       58 pts age matched with control EF < 45% AF with HF pts About 50% needed 2nd ablation Followup 12 + mths Showed   Improvement in LVEF & FS Reduced LVIDed, LVID es Hsu LF… Haissaiguerre M NEJM 2004 PABA CHF Composite Primary End Point of Ejection Fraction, 6-Minute Walk Distance, and Score on the Minnesota Living with Heart Failure Questionnaire at Months   PABA-CHF Conclusion Pulmonary-vein isolation was superior to atrioventricular-node ablation with biventricular pacing in patients with heart failure who had drug-refractory atrial fibrillation Khan MN et al N Engl J Med 2008;359:1778-1785 Remote magnetic Navigation - Stereotaxis – Value for complex ablation        Integration with CARTO Electro-Anatomical Navigation System Precise Tip Control – can move by mm precision Safety of GentleTouch Catheters Consistent Contact Reproducible navigation of ablation catheter Can reach sites that cannot or rarely be reached by conventional techniques Reduced Patient X-Ray Exposure Reduce X-ray exposure of Medical personnel Loss of PV potentials during ablation ESC AF Guidelines 2010 AF and CHF in 2010     Stroke prevention – most important Newer antithrombotic drugs may make it safer and easier Rate control and anticoagulation – acceptable approach especially in the elderly with more severe HF and long standing persistent AF Rhythm control – may be considered for younger pts with significant symptoms Ablation may be considered in a selected small number of pts ... for AF and HF pts Role of CRT in AF and HF      CRT indicated for pts with rapid AF who need AV node ablation + pacing RV pacing alone may be deleterious CRT may help prevent AF or reduce AF. ..     AF in HF is a/w higher mortality Does conversion to sinus rhythm improve survival Use of antiarrhythmic drugs may worsen outcome ?Role of new drugs for AF and HF AF in HF is a/w increased... in HF patients that had AF Role of beta blockers in AF and HF   It has never been established that beta-blockers improve morbidity and mortality in HF patients with AF Post hoc analyses of

Ngày đăng: 18/01/2018, 14:06

Từ khóa liên quan

Tài liệu cùng người dùng

  • Đang cập nhật ...

Tài liệu liên quan