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PHNG NGA RUNG NH

(PREVENTION OF ATRIAL FIBRILLATION)

BS L HU QUNH TRANG


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ATRIAL FIBRILLATION (AF)

www.mayoclinic.com


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AF

www.atrialfibrillation.org.uk


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European Heart Journal (2010) 31, 23692429


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Benjamin E J et al. Circulation 2009;119:606-618

Copyright American Heart Association


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EPIDEMIOLOGY

Vietnam: 0.3% population

2.2 million Americans

4.5 million people in the European Union It's the most common "serious" heart rhythm

abnormality in people over the age of 65years.


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Circulation. 2006; 114: 119-125; JAMA. 2001 May 9;285(18):2370-5; www.agingresearch.org


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SIGNIFICANCE OF PRBLEM

Increasing prevalence and incidence of AF

Many complications and high cost of AF

Medical and interventional treatments areavailable but are not without risk

An ounce of prevention is worth a pound of cure


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Prevention of AF

Risk factors that predispose individuals to thedevelopment of AF:

-Hyperthyroidism-Obstructive sleep apnea

-Obesity

-Atrial premature beats

-High NTproBNP

-PR prolongation

-

Hypertension-Congestive heart failure- Diabetes-Coronary artery disease-Valvular heart disease


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HYPERTHYROIDISM AND AF

-AF occurs in up to 15% of patients with hyperthyroidism-In all patients with AF, before treatment, we should remember the association withthyroid diseases, as sinus rhythm is often restored after normal levels of thyroidhormones are achieved

Thyroid Research 2009, 2:4


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HYPERTENSION AND AF

Most common risk factor

Diastolic dysfunction

Atrial stretch-fibrosis Use ACE inhibitors, Angiotensin II receptor

blockers reduction of fibrosis, atrialremodeling


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OBSTUCTIVE SLEEP APNEA(OSA) AND AF

Hemodynamic, neurohormonal, metabolicdisordersAF

OSA promotes development other risks of AF 2.2 fold increased risk for AF untreated OSA


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OBESITY AND AF

Circulation. 2013; 128: 401-405


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Venn diagram demonstrating overlap between obesity, atrial fibrillation, and selected

clinical correlates.

Magnani J W et al. Circulation 2013;128:401-405

Copyright American Heart Association

X 5


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PR PROLONGATION AND AF

JAMA. 2009;301(24):2571-2577. doi:10.1001/jama.2009.888


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ATRIAL PREMATURE BEATS AND AF

99% of people over the age of 50 had at leastone PAC on 24-hour Holter monitoring

Frequent PACs predicted that someone in the6.1-year follow-up would develop A-Fib.

European Society of Cardiology) (2012) 14, 942-947; Circulation October 9, 2012.


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NT-proBNP AND AF

The AF incidence associated with the lowest quintile ofbaseline BNP was 1.2% as compared to 5.1% in the 5th

quintile


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ATRIAL ENLARGEMENT AND AF

-Every 5-mm increase in LA diameter (TM) increased thedevelopment of AF by 39% (Framingham Heart Study)-A four-fold increase in the risk of new AF with LA diameter 0.5

mm (Cardiovascular Health Study)

Circulation. 1994;89(2):724730; Circulation. 1997; 96(7):24552461.


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AF RISK FACTORS

Obesity

Overweight

Hypertension

Heart Failure

Increased Left

Atrial Diameter(LAD)

Left Ventricular

Enlargement or

Hypertrophy

New OnsetAtrial

Fibrillation

Prussak, K. (2008). Prevention of New-Onset Atrial Fibrillation.


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ACEIs and ARBs

-Loartan>Atenolol -33% reduction in new-onset AF (LIFE)

-Valsartan>Amlodipin- new-onset AF was lessfrequent in the valsartan-treated group thanin the amlodipine-treated group (P = 0.0455)(VALUE)

-Ramipril >Placebo-reducing recurrence AF inlone AF (P


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STATINS

Decreased inflammation, oxidative stress,fibrosis

Risk reduction for new onset AF 28-52% inparticipants with IHD and CHF

Statin use preop ->risk reduction for postopAF 48-77%

QJM (2008) 101 (11): 845-861.


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OMEGA 3

Several small trials have suggested thattreatment for paroxysmal AF with prescriptionomega-3 fatty acids may provide a safe andeffective treatment option. However, nobenefit has been found to date

Pharmacological supplementation with 1 g of

n-3 PUFA for 1 year did not reduce recurrentAF.

J Am Coll Cardiol. 2013;61(4):463-468. doi:10.1016/j.jacc.2012.11.021


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