1. Atrial fibrillation Cardiology #2 Gimadeeva A.D.

2. Atrial fibrillation Cardaic arrhythmia that involves the two upper chambers (atrias) of the heart beat irregularly or quiver 1 in 25 people aged 60 and older 10% of people over 80 having AF 15-20% of all strokes

3. Classification Paroxysmal-first detected episode self- terrminates in less than 7 days Persistent-episodes lasts for more than 7 days Permanent-episode is ongoing for a long time

4. Signs & Symptoms Palpitation Exersize intolerance Angina Shortness of breath, edema

5. ECG

6. Echocardiography Identify valvular heart disease Left &right atria size Left ventricular size & function Peak right ventricular pressure Presense of left ventricular hypertrophy Pericardial disease

7. Transesophageal echocardiography Prefer when planning urgent electrical cardioversion for identifying thrombi & sluggish bloodflow Best visualisation of appandage- place,where thrombus most commonly is formed

8. Etiology High blood pressure Heart disease-coronary artery disease,mitral stenosis,mitral regurgitation, hypertrophic cardiomyopathy, pericarditis, heart surgery,congenital heart disease Lung disease Holiday heart syndrom Hyperthyroidism Carbon monoxide poisoning Dual-chamber pacemakers in the presense of normal AV-conduction

9. Goals of treatment To restore regular heart rate- medications,cardioversion,RFA To control the heart rate- digoxin,BB To prevent blood clots forming & causing strokes-Warfarin, Pradaxa, closure Watchman

10. Anticoagulation therapy Risk of thromboembolic events CHADS2 score (2001) CHA2DS2-VAS score (European guidelines) Risk of bleeding HAS-BLED score (2010)

11. For patients with CHA2DS2-VAS score of 2 or greater & HAS-BLED score of <3 anticoagulation CHA2DS2-VAS CHF or EF<35% AGE>75 -2p DM Prior TIA,CVA or emboli Vascular-prior PVD or MI Age 65-75-1 p Sex-female 1p HAS-Bled score Hypertension>160mmhg Abnormal kidney or liver function Stroke Bleeding history Labile INR(in range<60%) Elderly >65 Drugs(ASA,Plavix),>8 drink/week

12. Pradaxa,Dabigratan Direct thrombin inhibitors 110mg 2x 150 mg 2x Warfarin INR 2-3

13. Thanks for attention