Workshop VorhofflimmernFibrillation auriculaire

Nicola SchwickSwiss Cardiovascular Center Bern

University of Bern

Jürg Schläpfer, PD & MERMédecin adjoint

Service Cardiologie CHUV

Lausanne

Herbsttagung der SGK 2010Bern, 25.11.2010

•Classifications: « long standing persistent »

•EHRA score: symptoms in 4 classes

•CH2DS2VAsc score

•HAS-BLED score

•Rate control: lifestyle?

•Rhythm control: dronedarone

Guidelines: What’s New

1/2003 TIA4/2003 1st diagnosis of non ischemic CMP, LVEF 20%, severe MI, severe TI, enlarged atria, atrial fibrillation, tachycardia

Patient‘s history: „I know that my pulse is irregular from time to time“ „

?

Case SPmale 1941

DCM EF 20% pulmonary edema, tachyarrythmia

EF

?

Case SPmale 1941

Atrial fibrillationTOE: no thrombi in LAACHF therapy, rate control (betablocker, digoxin, amiodarone), anticoagulation normal puls limits with atrial fibrillation, NYHA II

Case SPdecision

DCM EF 20% pulmonary edema and.... ECG

Bounce back.......

EF

Case SPmale 1941

?

Catheter ablation of atrial flutter

Case SPdecision

SR, Amiodaron -> hyperthyroidism, AFib

2003 2007Verapamil stopped (accidentially)

Tachycardia, AFib

EF

Case SPmale 1941

?

Catheter ablation of atrial fibrillation

Case SPdecision

2009 SR2010 SR

2003 2007

CV

Ablation AFib

Ablation atrial Flutter

EF

Case SPmale 1941

Hsu LF al. NEJM 2004

58 pts with CHF and 58 pts without CHF matched undergoing AF ablation for symptomatic AF

Catheter Ablation for Afib in Congestive Heart Failure

Athlete (swimming, biking, running, iron man…)Symptomatic paroxysmal Afib since 4 years (2001)Does not want medicationOral anticoagulation because of thrombophilia and

pulmonary embolism

Case PCmale 1964

94 kg, 198 cm, normal blood pressure

Echo: LVEDD 48 mm, LVESD 34 mm, septum 9 mm, post wall 11 mm, LA 41 mm

-> Lone atrial fibrillation

Case PCmale 1964

Case PCmale 1964

Case PCmale 1964

?

Catheter ablation of atrial fibrillationPV isolation

Case PCdecisiob

MA

LUPV

LLPV

RUPV

RMPV

RLPV

Case PCdecision: PV isolation

Case PCwhile AF ablation

4.5 y FU (2010)Pulse control while runningShort episodes (10 sec) of fast heartbeatsoAK , no other medicationPatient is satisfied

Case PCFollow up

Calvo et al, Europace, online 18.11.2009

26

---- control vs. athletes ----

27

---- athletes vs. lone AF ----

---- control vs. athletes ---- including redo

The End