Management of atrial fibrillation 2016

Management of Atrial Fibrillation 2016: New Guidelines, Ablative Treatment, Drugs, Studies Nguyen Dinh Quang, MD Department of Electrophysiology Internal Medicine III, Cardiology St Vinzenz-Hospital Cologne Hoi Nghi Nhip Tim Toan Quoc Hanoi, November 26th, 2016 Hoi Nghi Nhip Tim Toan Quoc Hanoi, November 26th, 2016 Hoi Nghi Nhip Tim Toan Quoc Hanoi, November 26th, 2016 Hoi Nghi Nhip Tim Toan Quoc Hanoi, November 26th, 2016 Hoi Nghi Nhip Tim Toan Quoc Hanoi, November 26th, 2016 Antiarrhythmic drugs - Classification Hoi Nghi Nhip Tim Toan Quoc Hanoi, November 26th, 2016 Antiarrhythmic drugs “Sicilian Gambit” Hoi Nghi Nhip Tim Toan Quoc Hanoi, November 26th, 2016 Atrial fibrillation – rate control - when maintaining sinus rhythm is impossible • Betablockers (metoprolol, bisoprolol) • Ca-channel blockers (verapamil, diltiazem) • Digoxin/Digitoxin: in case of heart failure and in combination with betablockers / Ca-channel blockers • amiodarone Hoi Nghi Nhip Tim Toan Quoc Hanoi, November 26th, 2016 ESC Guidelines 2016: heart rate control Hoi Nghi Nhip Tim Toan Quoc Hanoi, November 26th, 2016 Atrial Fibrillation – Heart rhythm control Antiarrhythmic drug therapy Hoi Nghi Nhip Tim Toan Quoc Hanoi, November 26th, 2016 T.E Walters et al., Heart Rhythm 2016 Feb;13(2):331-9 10 Update Symposium Rhythmologie 21 September 2016 T.E Walters et al., Heart Rhythm 2016 Feb;13(2):331-9 10 Update Symposium Rhythmologie 21 September 2016 T.E Walters et al., Heart Rhythm 2016 Feb;13(2):331-9 10 Update Symposium Rhythmologie 21 September 2016 T.E Walters et al., Heart Rhythm 2016 Feb;13(2):331-9 10 Update Symposium Rhythmologie 21 September 2016 ESC Guidelines 2016: Frequenzkontrolle 10 Update Symposium Rhythmologie 21 September 2016 10 Update Symposium Rhythmologie 21 September 2016 T Jared Bunch et al Heart Rhythm 2013;10:1257–1262 10 Update Symposium Rhythmologie 21 September 2016 10 Update Symposium Rhythmologie 21 September 2016 C.A Morillo et al., JAMA 2014;311(7):692-699 T Jared Bunch et al Heart Rhythm 2013;10:1257–1262 10 Update Symposium Rhythmologie 21 September 2016 Metaanalysen zur Ablation als initiale Therapie bei paroxysmalem Vorhofflimmern Khan AR, Khan S, Sheikh MA, Khuder S, Grubb B, Moukarbel GV Catheter ablation and antiarrhythmic drug therapy as first- or second-line therapy in the management of atrial fibrillation: systematic review and meta-analysis Circ Arrhythm Electrophysiol 2014;7(5):853–60 Hakalahti A, Biancari F, Nielsen JC, Raatikainen MJ Radiofrequency ablation vs antiarrhythmic drug therapy as first line treatment of symptomatic atrial fibrillation: systematic review and meta-analysis Europace 2015;17(3):370– This is a meta- analysis of the three landmark randomized control trials of catheter ablation as first-line of therapy in AF patients The paper shows that catheter ablation is associated with 43% of relative risk reduction of AF recurrence compared with antiarrhythmic drugs After exclusion of RAAFT-1 trial (moderate– high risk of bias), catheter ablation was still associated with higher freedom from AF recurrence Santangeli P, Di Biase L, Natale A Ablation versus drugs: what is the best firstline therapy for paroxysmal atrial fibrillation? Antiarrhythmic drugs are outmoded and catheter ablation should be the first-line option for all patients with paroxysmal atrial fibrillation: pro Circ Arrhythm Electrophysiol 2014;7(4):739–46 10 Update Symposium Rhythmologie 21 September 2016 Vietnam – German Cardiology Scientific Symposium Hanoi, November 25th, 2016 Meta-analysis of first line catheter ablation in patients with paroxysmal atrial fibrillation Khan AR, Khan S, Sheikh MA, Khuder S, Grubb B, Moukarbel GV Catheter ablation and antiarrhythmic drug therapy as first- or second-line therapy in the management of atrial fibrillation: systematic review and meta-analysis Circ Arrhythm Electrophysiol 2014;7(5):853–60 Hakalahti A, Biancari F, Nielsen JC, Raatikainen MJ Radiofrequency ablation vs antiarrhythmic drug therapy as first line treatment of symptomatic atrial fibrillation: systematic review and meta-analysis Europace 2015;17(3):370–8 This is a metaanalysis of the three landmark randomized control trials of catheter ablation as firstline of therapy in AF patients The paper shows that catheter ablation is associated with 43% of relative risk reduction of AF recurrence compared with antiarrhythmic drugs After exclusion of RAAFT-1 trial (moderate– high risk of bias), catheter ablation was still associated with higher freedom from AF recurrence Santangeli P, Di Biase L, Natale A Ablation versus drugs: what is the best first-line therapy for paroxysmal atrial fibrillation? Antiarrhythmic drugs are outmoded and catheter ablation should be the first-line option for all patients with paroxysmal atrial fibrillation: pro Circ Arrhythm Electrophysiol 2014;7(4):739–46 Hoi Nghi Nhip Tim Toan Quoc Hanoi, November 26th, 2016 ESC Guidelines 2016 Hoi Nghi Nhip Tim Toan Quoc Hanoi, November 26th, 2016 Europace 2012 - doi:10.1093/europace/eus027 Hoi Nghi Nhip Tim Toan Quoc Hanoi, November 26th, 2016 T Jared Bunch et al Heart Rhythm 2013;10:1257–1262 Hoi Nghi Nhip Tim Toan Quoc Hanoi, November 26th, 2016 ... superiority of catheter ablation o Publications concerning first line therapy of paroxysmal atrial fibrillation show superiority of catheter ablation o Early ablative therapy after diagnosis of atrial fibrillation. .. 2016 Study details: Hypothesis: „is catheter ablation of atrial fibrillation as a first line therapy superior to antiarrhythmic drug therapy?“ 127 randomised patients with paroxysmal atrial fibrillation. .. antiarrhythmic drug therapy in patients with paroyxsmal atrial fibrillation Hoi Nghi Nhip Tim Toan Quoc Hanoi, November 26th, 2016 Catheter ablation of atrial fibrillation in patients with heart failure