guidelines on managemnet for AF whats new

guidelines on management for AF whats new

1. Guidelines for management for AF: What's new KUSH KUMAR BHAGAT MD, DM CARDIOLOGY

2. Clinical classification of atrial fibrillation based on pattern First diagnosed episode of AF LONG-LASTING PERSISTENT: Continuous AF > 1 year Rhythm control strategy adopted PERMANENT: Accepted by patient and physician Rhythm control not pursued PAROXYSMAL: episodes up to 7 days Termination is spontaneous or may require cardioversion PERSISTENT: continuous AF > 7 days May require cardioversion (direct or pharmacological) Early Persistent AF: AF episodes sustained > 7 days but < 3 months in duration Sources: Hindricks G, et al. Eur Heart J . 2021;42:373-498; Calkins H, et al. J Arrhythm . 2017;33:369-409. 2 Early Treatment for Atrial Fibrillation with Catheter Ablation

3. C atheter ablation guidelines ACC AHA 2017 Medtronic CAS | 4

4. 5 Medtronic CAS |

5. 6 Medtronic CAS |

6. C a se Presentation 2 S y m p t o m a tic P o st c on v e rs i o n p au s e s: SSS → Ne e d f o r PP M ? 6 Y ea r Ol d M W i th N o S tr u c tu r a l Hea rt Di s ea s e Re c u rr en t S y m p to m a t i c P AF (Paroxysmal Atrial Fibrillation W i th Fast Ventricular Rate : Tr e a te d W i th B B lo ck e r s . Pr e s en ts No w W i th Fr equen t Di zz ine s s

7. Cas e 2 What wo u l d y o u re c ommend? P P M an d continue Be t a B loc k ers P P M an d ad d An t iar r hy t hmi c medic a t i on R ea s s u re AF ablation

8. Underwent AF ablation Asymptomatic after that Pauses were present only after Spontaneous AF termination. No need of Pacemaker Class II A(ACC AND ESC)

9. ATRIAL FIBRILLATION 45yrs M Patient , history of recurrent Palpitation ECG: Paroxysmal Atrial Fibrillation 2D Echo: Normal On Amiodarone, Beta Blockers, Anticoagulant He Had recurrent Symptomatic Episodes Of PAF Despite Medications

10. What to recommend

11. CLASS I LOE A BOTH ACC AND ESC

12. Guidelines on strategy of af ablation

13. HRS Consensus Statement 1 “PVI is now widely accepted as the cornerstone of AF ablation procedures. Electrical isolation of the PVs is recommended during all AF ablation procedures.” 1 Calkins H, et al. J Arrhythm . 2017;33:369-409. 2 Haïssaguerre M, et al. N Engl J Med . 1998;339:659-666. Guideline recommendations for af ablation pulmonary vein isolation ( pvi ) is the cornerstone of af ablation 17 Early Treatment for Atrial Fibrillation with Catheter Ablation 2

14. ESC 2020 guidelines

15. Thank you

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17. 1 January CT, et al. Circulation . 2014;130:2071-2104. 2 Calkins H, et al. Europace . 2018;20:e1-e160. 3 Hindricks G, et al. Eur Heart J . 2021;42:373-498. Summary of guidelines for catheter ablation of symptomatic paroxysmal af prior to aad failure 2014 AHA/ACC/HRS Guideline for the Management of Patients with AF In patients with recurrent symptomatic paroxysmal AF, catheter ablation is a reasonable initial rhythm control strategy prior to therapeutic trials of antiarrhythmic drug therapy, after weighing risks and outcomes of drug and ablation therapy ( IIa , B) 1 2017 HRS/EHRA/APHRS/SOLAECE Expert Consensus Statement on Catheter and Surgical Ablation of AF Catheter ablation is reasonable prior to initiation of AADs ( IIa , B-R) 2 2020 ESC Management of Atrial Fibrillation Guidelines AF catheter ablation for PVI should be considered for rhythm control after one failed or intolerant to beta-blocker treatment ( IIa , B) 3 Should/may be considered as first-line rhythm control therapy to improve symptoms in selected patients with symptomatic paroxysmal AF episodes ( IIa , B) 3 32 Early Treatment for Atrial Fibrillation with Catheter Ablation