Journal

Reading

Atrial Fibrillation :
Diagnosis and Management
(ESC 2010,2012)

dr. Mohamad Ananto C*

dr. Dadang Hermawan, SpJP (K)**
* Resident of Internal Medicine, Faculty of Medicine Brawijaya University,
Saiful Anwar Hospital, Malang
* Supervisor Cardiology Department, Faculty of Medicine Brawijaya
1
University,
Saiful Anwar Hospital, Malang

Introduction
The current estimate of the prevalence of atrial
fibrillation (AF) in the developed world is approximately
1.52% of the general population
The arrhythmia is associated with a five-fold risk of
stroke
and a three-fold incidence of congestive heart failure,
and higher mortality.
Fortunately a number of valuable treatments have been
devised in recent years that may offer some solution to
this problem.

Epidemiolog
y

AF affects 12% of the population, and this

figure is likely to increase in the next 50
years.

Men are more often affected than women.

The prevalence of AF increases with age, from

<0.5% at 4050 years, to 515% at 80 years.

Definition
A cardiac arrhytmia with the following
characterictics :
(1)The surface ECG shows absolutely
irregular RR intervals
(2)There are no distinct P waves on the
surface ECG.
(3) The atrial cycle length (when
visible),ie interval between two atrial
activations, is usually variable and
<200 ms (>300bpm)
4

Types of Atrial Fibrillation

Screening for Atrial Fibrillation

Cardiovascular condition
associated with atrial fibrillation

Non Cardiovascular condition

associated with atrial fibrillation
Ageing

Coronary artery disease

Tyroid dysfunction

Cardiomyopathies

COPD

Valvular heart disease

Symptomatic Heart failure

Diabetes Mellitus

Atrial Septal Defect

Obesity
Hypertension

Sleep apnoea

Other Congenital heart

disease

Cronic Renal
Disease

Mechanisms of atrial fibrillation

Atrial Factors
- Pathophysiological changes preceding AF

- Pathophysiological changes as a
consequence of AF

Electrophysiological mechanism

Focal mechanism

The multiple wavelet hypothesis

Genetic Predisposition

Clinical correlates

AV Conduction

Hemodinamic changes

Trombo-embolism
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MANAGEMENT

Antithrombotic
Rate and rhythm
Long-term management
Upstream therapy
11

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Antithrombotic management

14

Novel oral Anticoagulant

Dabigatran
Rivaroxaban
Apixaban

15

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Long-term
management

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Cardioversion with Pharmacological

agents

Amiodaron
Flecainide
Ibutilide
Propafenone
Vernakalant

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Catheter ablation of Atrial

Fibrillation

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 LV
hemodynamic
s

Atrial
stretch /
dilation

Activates
RAAS

AF

Fibrosis

production of
connective
tissue growth
factor

Increase
Angiotensin II
& TGF-1

Electrical &
structural
remodeling

Inducing &
maintaining
AF

VHD, HF, HT,

CAD

Why should you use

ACEi/ARB?
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Thank You

26

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Antithrombotic
management

28

Antithrombotic
management

29

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Rate and rhythm

management

32

Long-term
management

33

Upstream therapy

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