Description
The treatment of people with atrial fibrillation (AF), which is shifting toward a more integrative or holistic approach to care, centers on the prevention of strokes. According to published data, managing patients with atrial fibrillation (AF) with a comprehensive approach based on the Atrial fibrillation Better Care (ABC) pathway is linked to a decreased risk of adverse events and stroke. For AF patients to prevent stroke, risk assessment, reassessment, and the administration of direct oral anticoagulants (DOACs) are crucial. Patients with AF should have their risks of bleeding and stroke routinely reevaluated because they are not static. The goal of bleeding risk assessment is to identify individuals at high risk for early review and follow-up, as well as to address and mitigate modifiable bleeding risk factors. Additionally crucial are well-managed comorbidities and healthy lifestyles.
Résumé
- Atrial fibrillation (AFib) is a heart rhythm disturbance where the heart beats irregularly and often rapidly, caused by multiple impulses originating in the atria. This condition becomes more prevalent with age, improved cardiovascular treatments, and increasing rates of diabetes and hypertension. The irregular rhythm can lead to symptoms like breathlessness and palpitations, due to the loss of effective atrial contraction and increased ventricular rate. AFib is classified as paroxysmal (episodic) or persistent (continuous), with aging, hypertension, valvular heart diseases, electrolyte imbalances, and pulmonary conditions being common causes.
- Diagnosis of AFib involves ECG recordings, which show irregular QRS complexes and absent P waves. Paroxysmal AFib may require Holter monitoring to capture episodes. Device interrogation in patients with pacemakers or ICDs can also reveal AFib events. Although many patients are asymptomatic, the condition can lead to complications such as heart failure and increased risk of systemic embolization.
- Embolic complications, particularly ischemic stroke, are a significant concern in AFib patients. The stasis of blood in the left atrial appendage can lead to thrombus formation and subsequent embolization. The risk of stroke is assessed using the CHA2DS2-VASc score, which considers factors like congestive heart failure, hypertension, age, diabetes, stroke history, and sex. Scores of two or more indicate the need for anticoagulation to prevent these embolic events.
- Anticoagulation therapy is crucial for managing the embolic risk in AFib. Vitamin K antagonists like Warfarin were historically used, but require regular INR monitoring and have numerous interactions. Newer oral anticoagulants (NOACs), such as rivaroxaban, dabigatran, and apixaban, offer predictable effects, less need for monitoring, and reduced interactions. Clinical trials have established their superiority in terms of efficacy and reduced bleeding risk compared to Warfarin.
- Despite the advantages of NOACs, Vitamin K antagonists remain the recommended option for patients with mechanical prosthetic heart valves and familial thrombophilic states. Caution is advised when using NOACs in high-risk groups, such as those with malignancy, severe kidney disease, or a recent intracranial bleed. A tailored approach considering both the CHA2DS2-VASc and HAS-BLED scores is essential to optimize anticoagulation strategies in AFib patients.
- Catheter ablation can be considered for younger patients without significant structural heart disease, where the source of irregular impulses are ablated using cryo or balloon techniques. The success rate is around 65-70%, but in most situations the results are better without electrophysiological procedures. The decision to pursue ablation should be made in consultation with an electrophysiologist.
Exemple de certificat
À propos des intervenants
Dr. Rishi Lohiya
Consultant Interventional Cardiologist , KIMS Kingsway hospital and Healthy Heart Clinic, Nagpur
Divulgation financière
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