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1、Atrial Fibrillation a simple pulse check to prevent a stroke?,Dr Kneale Metcalf,Overview,Atrial fibrillation Stroke and atrial fibrillation Detecting atrial fibrillation Managing atrial fibrillation,What is atrial fibrillation (AF)?,“Atrial fibrillation is an atrial tachyarrhythmia characterised by
2、predominantly uncoordinated atrial activation”,“A fast / irregular heart”,What happens in the heart?,Sinus rhythm,AF,ECG,Most commonly diagnosed by an ECG:,Classification of AF,The Incidence of AF is Increasing in the United Kingdom,In 1995, 0.9% of the United Kingdom population were affected by AF2
3、 By 2006 this figure had risen to 1.3%1 The prevalence of AF will continue to rise as the proportion of elderly patients increasesBy 2050, it is estimated that AF will be present in 2% of the general population, and in a far higher proportion of elderly patients2,NICE Clinical Guideline 36 costing r
4、eport. Available at: http:/www.nice.org.uk/nicemedia/pdf/CG036costingreport.pdf. Accessed January 14, 2010 Stewart S, et al. Heart 2004; 90: 28692; 3. Savelieva I, et al. Europace 2008; 10: 64765,Other points about AF,Can be symptomatic or asymptomatic If asymptomatic then how do you pick it up?,Cor
5、e message,Atrial fibrillation is common and getting commoner,AF and stroke,Wolf et al. Stroke 1991; 22: 983-988,One sixth of all strokes are attributable to AF,AF is an Independent Risk Factor for Stroke,AF patients have nearly a fivefold increased risk of stroke compared with patients without AF1,1
6、. Wolf PA, et al. Stroke 1991; 22: 9838,5059,6069,7079,8089,4,3,2,1,0,5,Age (years),4.0,2.6,3.3,4.5,Relative risk of stroke compared to patients without AF,p0.001 for all age groups,The Impact of AF on Stroke Outcomes,Survival is poorer and stroke recurrence rates are higher following AF-related str
7、oke,AF=atrial fibrillation; OR=odds ratio; CI=confidence interval 1. Lin HJ, et al. Stroke 1996; 27: 17604; 2. Dulli DA, et al. Neuroepidemiology 2003; 22: 11823,Framingham (10-year follow up from 1981),AF=atrial fibrillation; OR=odds ratio; CI=confidence interval Dulli DA, et al. Neuroepidemiology
8、2003; 22: 11823,Patients bedridden on admission (%),p75 years 1 point Diabetes mellitus 1 point Stroke or TIA 2 points,Aspirin,Stroke reduction of 19% (95% CI 2% to 34%),Warfarin,Risk reduction of 62% (95% CI 48% to 72%) versus placebo,RE-LY Trial (Dabigatran),Dabigatran Direct thrombin inhibitor NO
9、N MONITORED ANTICOAGULATION 18000 patients, compared to warfarin 150mg better than warfarin (RRR 34%),Rate / rhythm control,Beta blockers Amiodarone Flecainide Digoxin Etc.New antiarrhythmic agent Dronederone Cleaner amiodarone Trial = ATHENA 4628 patients (PAF) 24% RRR of hospitalisation or death from any cause,
