Suvremena Terapija Atrijalne Fibrilacije K antonal na Bolnica Zenica. Enes Abdović. “ Atrial fibrillation (AF), an ‘old’ arrhythmia first described in 1909, ….
Suvremena Terapija Atrijalne FibrilacijeKantonalnaBolnica Zenica
Abdovic et al. Europace 2005
Abdovic E. et al. Europace, 2005
Abdovic et al. Europace 2005
The interrelations between AF and CHF could constitutea vicious cycle. However, both conditions may bemarkers of a common pathophysiological substrate. Accordingto data from the Framingham Heart Study, AF precededCHF about as often as CHF preceded AF, and in one-fifth of
subjects, AF and CHF were diagnosed for the first time onthe same day.
Moe’s theorythe multiple reentry wavelethypothesisMoe GK. On the multiple wavelet hypothesis of atrial fibrillation.Arch Int Pharmacodyn Ther 1962;140:183–8.
Experimental and clinical studies have shown that AF is maintained by multiple reentrant wavelets within the atrial muscle.
It has been estimated that a critical number of wavelets (from 3 to 6) is necessary for perpetuation of AF...
Sick sinus syndrome
(Intra, inter) atrial level
Intra- and inter-atrial blocks
P-wave duration is generally accepted as the most reliablenon-invasive marker of atrial conduction and its prolongation has been associated with historyof AFPlatonov PG, Cardiol J. 2008, 15;402-408
Efficacy of amiodarone compared with control for the (A) prevention of sudden cardiac death, (B) cardiovascular death, and (C) all-cause mortality in patients with cardiomyopathy(Piccini JP et al, 2009 E Heart J)
Stroke risk in patients with AFaccording to the CHADS2 risk index.The colour codedbar graphs indicate the appropriate antithrombotictreatment strategy.
The Watchman Left Atrial Appendage Closure DeviceThe device is a self-expanding nitinol structure that is delivered percutaneously with femoral venous access and transseptal technique to the LAA. The device is positioned with the use of angiography and TEE, and implantation is performed in either a cardiac catheterization or electrophysiology laboratory with the patient under general anesthesia or conscious sedation.
The Maze procedureBlack lines delineate surgical incisions in both the right and left atria, encircling the pulmonary veins (PV) and around the coronary artery sinus orifice. The atrial appendages are also excluded.
Diagram of the Sites of 69 Foci Triggering Atrial Fibrillation in 45 Patients.Note the clustering in the pulmonary veins, particularly in both superior pulmonary veins. Numbersindicate the distribution of foci in the pulmonary veins.
Schematic depiction of different ablation techniques targeting the lateralpulmonary veins (PVs).(A) Simultaneous isolation of the ipsilateral PVs by a long ‘‘pointby-point’’ lesion encircling the antrum area of the lateral PVs. (B) ‘‘Single shot’’ PV isolation using aballoon shaped catheter aiming at the LIPV.
… the statement of international societies concerning AF ablation and ablation guidelines cannot include class A recommendation as prospective comparative randomized trials are not available.
Registries such as the one conducted by Dr Cappato are useful but the long –term results are difficult to evaluate with a registry.
The CABANA trial will cover this gap and will randomize recent onset paroxysmal AF to antiarrhythmic medications or to ablation, which will include pulmonary vein isolation as a minimum procedure.
The primary endpoint will be mortality and secondary endpoints will include cardiovascular death, hospitalizations, heart failure, cost and quality of life.