what are my treatment options for af
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What Are My Treatment Options for AF? Mikhael El-Chami, MD FACC, FHRS Emory Heart and Vascular Center Atrial Fibrillation (AF, Afib) Epidemiology of AF Treatment Options for AF Epidemiology Estimated 6 million people in U.S. with

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  1. What Are My Treatment Options for AF? Mikhael El-Chami, MD FACC, FHRS Emory Heart and Vascular Center

  2. Atrial Fibrillation (AF, Afib) ■ Epidemiology of AF ■ Treatment Options for AF

  3. Epidemiology ■ Estimated 6 million people in U.S. with AF ■ 15.9 million by 2050 ■ A 66% increase in hospital admissions for AF in last 20 yrs ■ Aging population ■ Increase in obesity and sleep apnea ■ Rising prevalence of chronic heart disease Feinberg WM et al. Arch Intern Med . 1995;155:469-473 Holmes DR et.al. Lancet 2009

  4. AF is Associated with Higher Stroke and Mortality Rate Two fold ■ Five fold ■

  5. Treatment of AF ■ Treating symptoms a.Rhythm control b.Rate control ■ Reducing stroke risk (morbidity and mortality)

  6. Treating Symptoms ■ 72 yo man referred by his PCP for a second opinion regarding AF treatment. He denied shortness of breath fatigue chest pain. He continue to walk 2 miles per day and has no limitation. He has known AF for 2 years. He is on coumadin, amlodipine and metoprolol

  7. How Would you Treat this Patient? ■ Ablation ■ Cardioversion ■ Antiarrhythmic Drugs ■ No treatment

  8. How Would you Treat this Patient? ■ NO TREATMENT ■ If AF is asymptomatic ■ NO INVASIVE PROCEDURE IS NEEDED IN THE MAJORITY OF CASES

  9. Case-2: Treatment ■ Mrs CA is a 65 yo female fairly active has history of hypertension and diabetes. Was diagnosed with AF 2 years ago . She has been having increasing episode of AF lasting 3-24 hrs and occurring on a weekly basis. During those episodes she feels “wiped out”, she can’t perform her usual tasks without shortness of breath and easy fatiguability. She is on the following meds: Metoprolol 50 mg Pradaxa 150 mg Lisinopril 20 mg

  10. How Would you Treat this Patient? ■ Ablation ■ Cardioversion ■ Antiarrhythmic Drugs ■ No treatment

  11. Symptomatic AF ■ Prevent its occurrence ■ Antiarrhythmic drugs: ■ Flecainide ■ Propafenone ■ Sotalol ■ Tikosyn ■ Amiodaorne

  12. Case-3 ■ Mrs CA was started on flecainide 100 mg twice a day, she did great for 1 year but presents back with recurrence of AF and significant symptoms. Her symptoms are occuring almost weekly and her longest episode was 12 hours.

  13. How Would you Treat this Patient? ■ Ablation ■ A different Antiarhythmic ■ Pacemaker ■ No treatment

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