Αντιαρρυθμική και αντιπηκτική αγωγή στην κολπική μαρμαρυγή. Ασθενής με κρυπτογενές ΑΕΕ

Μέγεθος: px

Εμφάνιση ξεκινά από τη σελίδα:

Download "Αντιαρρυθμική και αντιπηκτική αγωγή στην κολπική μαρμαρυγή. Ασθενής με κρυπτογενές ΑΕΕ"

Ευτρόπιος Παπαδόπουλος
6 χρόνια πριν
Προβολές:

1 Αντιαρρυθμική και αντιπηκτική αγωγή στην κολπική μαρμαρυγή Ασθενής με κρυπτογενές ΑΕΕ Ιουλία Γράψα MD, PhD, FRCP, FAHA, FESC Επιμελήτρια καρδιολογιας, Επιτιμη επικουρη καθηγητρια, Imperial College of London Προεδρος EACVI heart imagers of tomorrow, European Society of Cardiology

2 Disclosures Δεν ειμαι ηλεκτροφυσιολόγος Αλλά: Βλεπω εναν σημαντικο αριθμο ασθενων με νεα κολπικη μαρμαρυγη και ενα ποσοστο εκ των αυτων εχει προηγηθεν κρυπτογενες ΑΕΕ Εχουμε Rapid Access Arrthyhmia clinic με πολλες παραπομπες ασθενων με κρυπτογενες ΑΕΕ

Κρυπτογενες αγγειακο εγκεφαλικο επεισοδιο ~800,000 new or recurrent strokes yearly 87% ischemic; 13% hemorrhagic 690,000 ischemic strokes every year in the US Approximately 200,000 cryptogenic

3 Κρυπτογενες αγγειακο εγκεφαλικο επεισοδιο ~800,000 new or recurrent strokes yearly 87% ischemic; 13% hemorrhagic 690,000 ischemic strokes every year in the US Approximately 200,000 cryptogenic strokes (CS) annually2 Diagnosis and management of cryptogenic stroke is unclear by many health professionals Cross-collaboration by HCPs along the CS treatment continuum is limited Breadth of monitoring clinical research on CS is limited

4 Minimum workup for cryptogenic stroke Noncontrast brain CT or brain MRI Blood glucose Oxygen saturation Serum electrolytes/renal function tests Complete blood count, including platelet count Markers of cardiac ischemia Prothrombin time/international Normalized Ratio (INR) Activated partial thromboplastin time Electrocardiogram Echocardiogram (TTE/ TOE) Dr. Julia Grapsa

5 Αφορά κάθε καρδιολόγο: κύρια αιτία: υποκρύπτων AF Dr.Julia Grapsa

6 Ανακάλυψη κολπικής μαρμαρυγής Holter monitor Telemetry Implantable Loop Recorders CRYSTAL-AF AF detection in cryptogenic stroke patients increases over time For those patients with detected AF in the ICM arm, the duration was more than 6 minutes on one or more days in > 94% of patients Physicians took action when AF was found with 89% of patients being prescribed OAC Majority of first AF episodes (75%) were asymptomatic At 36 months, more than 250 tests were required in order to find 5 patients with AF in the control arm The time to first AF detection was beyond the time-frame of typical external monitors Long-term continuous monitoring should be performed in patients with cryptogenic stroke Speaker

7 Ανακάλυψη κολπικής μαρμαρυγής: πολυ σημαντική! 25% AF patients: presentation as stroke Most common cause after hypertension Anticoagulation, antiplatelets & antiarrthythmics Worth considering coagulopathies or inheritable diseases in young patients and malignancies in older patients

8 Speaker

EMBRACE trial Randomly assigned 572 patients 55 years of age or older, without known atrial fibrillation, who had had a cryptogenic ischemic stroke or TIA within the previous 6 months Additional

9 EMBRACE trial Randomly assigned 572 patients 55 years of age or older, without known atrial fibrillation, who had had a cryptogenic ischemic stroke or TIA within the previous 6 months Additional noninvasive ambulatory ECG monitoring with either a 30-day eventtriggered recorder (intervention group) or a conventional 24- hour monitor (control group). CONCLUSIONS PAF was common. Noninvasive ambulatory ECG monitoring for a target of 30 days significantly improved the detection of atrial fibrillation Primary outcome was newly detected atrial fibrillation lasting 30 seconds or longer within 90 days after randomization. Secondary outcomes included episodes of atrial fibrillation lasting 2.5 minutes or longer and anticoagulation status at 90 days

10 EMBRACE trial Dr. Julia Grapsa

11 Stroke prevention & treatment in the year 2015 Atrial fibrillation CHA 2 DS 2 -VASc 1 Antiplatelets ASA/Clopidogrel Warfarin (Or sintrom) Already on treatment without complication Regular visits necessary for secondary disease NOACs (Dabigatran, rivaroxaban, apixaban) Be careful with renal impairment and bleeding risk? Dr. Julia Grapsa

12 Δυσκολες περιπτωσεις: Τι συμβαινει οταν ο ασθενης δεν μπορεί να πάρει φαρμακευτική αγωγή; Dr. Julia Grapsa

13 Στην καθ ημέρα κλινική πράξη 78 yrs old male patient Stroke with good recovery (modified Rankin Score 1) Asymptomatic, paroxysmal AF CT: small microemboli (relative contra-indication for long termoral anticoagulation) GFR 45 mls/min secondary to chronic hypertension Hypertensive on 3 agents

14 AHA/ASA Guidelines for cryptogenic stroke (2014) ESC guidelines on Atrial Fibrillation Dr.Julia Grapsa

15 Speaker 2014

16 PROTECT-AF study Dr.Julia Grapsa

17 Stroke prevention in the year 2015 Atrial fibrillation CHA 2 DS 2 -VASc 1 Warfarin Already on treatment without complication Regular visits necessary for secondary disease NOACs (Dabigatran, rivaroxaban, apixaban) Be careful with renal impairment and bleeding risk LAA occlusion +/- 3 months ASA/Clopidogrel ACS / triple therapy to be discussed Bleeding risk Dr.Julia Grapsa

18 Λιγο πριν το τέλος: τροφή για σκέψη... PAF & cryptogenic stroke: role of PAF ablation Dr.Julia Grapsa

19 Speaker Sent by Dr. Julian Jarman, RBH

remodelling: a study with 3D strain Maria Agelaki, Julia Grapsa, David Dawson, Costas Papadopoulos, Petros Nihoyannopoulos,

20 To ablate or not to ablate? Early ablation in paroxysmal atrial fibrillation demonstrates significant benefit in atrial function and reverse remodelling: a study with 3D strain Maria Agelaki, Julia Grapsa, David Dawson, Costas Papadopoulos, Petros Nihoyannopoulos, Apostolos Katsivas (Best abstract Cardiostim 2015, Milan) Conclusions: Early PAF ablation benefits atrial and ventricular function by increasing regional strain and strain rate and leading to reverse atrial remodelling. Dr.Julia Grapsa

21 Τελευταία διαφάνεια...λίγη υπομονή ακόμα.. Speaker

22 Important: Transition from Club 35 to HIT Club 35 = Heart Imagers of Tomorrow (HIT) Inclusion criteria: Under 38 years of age Or in training (with proof the letter from the head of the department) New membership 2016: 65 euros as annual fee Dr. Julia Grapsa

23 Σας ευχαριστω πολυ για την προσοχη σας! Dr. Julia Grapsa

Σχετικά έγγραφα

Ασθενής συνεχίζει να εμφανίζει θρομβοεμβολικές επιπλοκές παρότι λαμβάνει καλά ρυθμιζόμενη αντιπηκτική αγωγή με βαρφαρίνη

Ασθενής συνεχίζει να εμφανίζει θρομβοεμβολικές επιπλοκές παρότι λαμβάνει καλά ρυθμιζόμενη αντιπηκτική αγωγή με βαρφαρίνη Δημήτριος Λυσίτσας, MD, PhD, MRCP Επεμβατικός Ηλεκτροφυσιολόγος, Θεσσαλονίκη Senior