Efficacy and Safety of Pharmacological Options for Rate Control in Atrial Fibrillation
|
|
- Abigail Griffin
- 8 years ago
- Views:
Transcription
1 AACN Advanced Critical Care Volume 23, Number 2, pp , AACN ECG Challenges Earnest Alexander, PharmD, and Gregory M. Susla, PharmD Department Editors Efficacy and Safety of Pharmacological Options for Rate Control in Atrial Fibrillation Katie O Brien, PharmD Earnest Alexander, PharmD L indsay Patel, PharmD, BCPS Atrial f ibrillation (AF) is the most common arrhythmia, and its prevalence will continue to increase as people age. Approximately 3 million people in the United States currently have AF, with an estimated 7.5 million people by the year Atrial fibrillation is characterized by uncoordinated atrial firing, which disrupts the normal sinus rhythm of the heart. The arrhythmia can be classified by the occurrence of its symptoms, such as first episode, recurrent, paroxysmal, and persistent. When AF is not controlled, the symptoms may be severe and interrupt a patient s activities of daily life. Mortality rates of patients with AF are double those of patients in normal sinus rhythm. 2 Furthermore, AF may require urgent treatment to prevent or correct events suc h as stroke, thromboembolism, and hemodynamic compromise. Although the underlying cause of AF is unknown, several disorders contribute to its development. Hypertension, diabetes, and congestive heart failure are just a few causes that can contribute to the clinical risk factors for AF. On the basis of the potential negative clinical outcomes, health care providers must understand the role of pharmacological management strategies that can improve quality of life and care in patients with AF. Rhythm Control Versus Rate Control When a patient is diagnosed with persistent or permanent AF, pharmacological management of either heart rate or rhythm is the mainstay of treatment. Under normal conditions, cardiac output is directly related to heart rate and stroke volume. Increases in heart rate and/or stroke volume generally result in a proportional increase in cardiac output. During AF, the atria of the heart quiver, resulting in diminished atrial filling, decreased stroke volume, and decreased cardiac output. During AF with rapid ventricular response (RVR), cardiac output is further decreased by both quivering atria and fast ventricle contraction because of reduced atrial and ventricular filling. Pharmacological management strategies are based on improving atrial and ventricular filling and increasing cardiac output. Rate control therapy aims to manage the ventricular rate, whereas rhythm control strives to restore or maintain normal sinus rhythm. Both strategies result in increased cardiac output. Over the last 10 years, a few trials have shed light on the ongoing controversy concerning the rhythm versus management strategies and which is Katie O Brien is Clinical Pharmacist, Tampa General Hospital, 1 Tampa Genera l Circle, Tampa, FL (ko brien@tgh.org). Earnest Alexander is Clinical Manager, Department of Pharmacy Services, and Critical Care Pharmacy Residency Program Director, Tampa General Hospital, Tampa, Florida. Lindsay Patel is Clinical Pharmacist, Tampa General Hospital, Tampa, Florida. The authors have no relevant financial or personal relationships to disclose. DOI: /NCI.0b013e318242fdd0 120
2 VOLUME 23 NUMBER 2 APRIL JUNE 2012 Drug Update the preferred option. The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial sought to determine whether the strategy or the rhythm control strategy was associated with a better survival outcome. 3 The AFFIRM study was a large, randomized controlled trial evaluating a population of more than 4000 patients with AF with RVR. Inclusion criteria led to the enrollment of patients who were at least 65 years old or had 1 other risk factor for stroke or death. Mean duration of patient follow-up for the trial was 3.5 years. Patients in the arm of the study received digoxin, -blockers, or calcium-channel blockers. Amiodarone and sotalol were the agents used in the rhythm control arm. The stu dy defined as an average heart rate of less than 80 beats per minute and a maximum heart rate of less than 100 beat s per minute during a 6-minute walk or an average heart rate of less than 100 beats per minute over a 24-hour period. No statistically significant differences in overall mortality were reported between the 2 groups (25.9% and 26.7%, respectively; heart rate: 1.15 beats per minute; 95% confidence interval: ; P.08). 3 The study was the first of its kind to show that is equally effective as rhythm control in terms of overall mortality. This study has changed the management of patients with AF with RVR, shifting the focus of treatment to strategies rather than rhythm control. The AFFIRM study has helped to establish the role of in the management of patients with AF with RVR. With trials such as AFFIRM and other studies establishing a role for strategies, this topic deserves further elaboration. Compared with antiarrhythmic medications (used in rhythm control), agents used for are generally considered safer and better tolerated. Agents used for include digoxin, -blockers, and nondihydropyridine calcium-channel blockers. Refer to Table 1 for an overview of dosing and other considerations. This column discusses and evaluates specific nuances of, targeting efficacy and safety of specific agents, management of in an emergent setting, and the intensity of rate control. Digoxin Digoxin is a cardiac glycoside exhibiting its mechanism of action by binding to the sodium and potassium adenosine triphosphatase pump, which eventually increases calcium ions, which results in a prolonged cardiac action potential decreasing heart rate. Once considered the firstline agent in emergent settings for, digoxin has since fallen out of favor with the publication of studies proving other agents to be more appropriate in certain settings. Digoxin acts relatively slowly when given intravenously, taking approximately 60 minutes to work, with peak effects not being reached for at least 6 hours. Furthermore, digoxin has a narrow therapeutic index, with a target dose range of to mg orally once daily. The drug may have toxic or suboptimal effects when levels fall outside the therapeutic range of 0.5 to 2.0 ng/ml. Appropriate dosing is critical, especially in patients with renal dysfunction, and close monitoring for therapeutic levels is a key consideration with this agent. Despite these considerations, digoxin may benefit patients who do not respond to other options alone. Previous studies have examined the usefulness of digoxin and its efficacy in AF therapy. Wattanasuwan and colleagues 4 evaluated the differences between intravenous diltiazem alone to control rate in patients with AF with RVR and a combination of intravenous digoxin and diltiazem. Successful was defined as a ventricular rate of less than 100 beats per minute persisting for 1 hour or conversion to sinus rhythm. Loss of was significantly less in the combination group than in the diltiazem-alone group (14 vs 39 episodes; P.05). The length of time taken to achieve (mean SD) was also shorter for the combination group (15 16 minutes vs minutes; P.20), but this difference was not statistically significant. 4 Patients who are sedentary and do not require exercise tolerance may benefit from digoxin therapy because it is not effective when sympathetic activity is increased. Digoxin is a positive inotropic agent and can be advantageous to patients with AF and heart failure with systolic dysfunction, especially when used in combination therapy with diltiazem in situations in which conversion to sinus rhythm is not indicated. Digoxin is also an option for patients who cannot tolerate further blood pressure lowering as seen with other agents. -Blockers -Blocke rs work by blocking the effects of norepinephrine and epinephrine. -Blocke rs are 121
3 Drug Update AACN Table 1: Rate Control Medication Overview Drug Purpose Dose Administration Acebutolol Maintenance Maintenance: mg/d Oral orally in divided doses (max: 1200 mg/d) Digoxin Emergent or maintenance Emergent: Normal renal function: 500 mcg IV x 1, then 250 mcg IV (6 h after the first dose) x 2 Renal failure: 250 mcg IV x 1, then 125 mcg IV (6 h after the first dose) x 2 Oral or IV Monitoring Parameters glucose, blood pressure, orthostatic hypotension, heart rate, CNS effects Monitor for low blood pressure when given IV; monitor digoxin levels: therapeutic range ng/ml Maintenance: mg orally daily Diltiazem Emergent or maintenance Emergent: Rate control: 0.25 mg/kg over 2 min, if no response, may repeat with 0.35 mg/kg after 15 min Oral or IV pressure, LFTs, heart rate Lenient : 0.2 mg/kg over 10 min Maintenance: Continuous infusion: Start at 5-10 mg/h, increase up to 15 mg/h Oral maintenance: dosing varies Esmolol Emergent rate control Emergent: 1000 mcg/kg IV bolus over 30 s, followed by a 50 mcg/kg per min continuous infusion; may increase in 50 mcg/kg per min increments as needed every 4 min to a max rate of 300 mcg/kg per min IV pressure, MAP, heart rate, respiratory rate Metoprolol Emergent or maintenance Emergent: mg IV every 2 5 min (max: 15 mg over a 10-min period) Oral or IV pressure, heart rate Pindolol Maintenance Maintenance: mg/d orally immediate release (max: 400 mg/d) Maintenance: mg orally daily (max: 60 mg/d) Oral pressure, heart rate, respiratory function Abbreviations: CNS, central nervous system; IV, intravenous; LFTs, liver function tests; MAP, mean arterial pressure; max, maximum. 122
4 VOLUME 23 NUMBER 2 APRIL JUNE 2012 Drug Update sympatholytic drugs affecting both beta1 ( 1 ) receptors and beta2 ( 2 ) receptors, depending on the drug s selectivity. The heart contains both 1 and 2 receptors but mostly comprises 1 receptors. 2 Receptors are located in the vascular smooth muscle. By blocking both these effects, heart rate (chronotropy) and contractility (inotropy) are decreased by -blockers. 5 The intravenous use of -blockers can be beneficial in an acute setting in patients who are candidates for -blocker therapy for whom rate control is indicated. Esmolol, propranolol, and metoprolol have been used intravenously in the emergent setting to control rate. These agents have a rapid onset of about 5 minutes. Esmolol has a very short half-life of approximately 9 minutes and has the advantage of its metabolism being independent of both hepatic and renal function. This unique characteristic provides value in patients who have multisystem organ failure or who are critically ill and their organ function cannot be assessed. However, esmolol must be given as a continuous infusion, whereas metoprolol and propranolol can be administered as intermittent intravenous injections. Esmolol is dosed as an initial 1000 mcg/kg loading dose over 30 seconds, followed by a 50 mcg/kg per minute infusion. Infusions may be titrated by 50 mcg/kg per minute increments as needed every 4 minutes up to a relative maximum dose of 3 00 mcg/kg per minute. Esmolol is a popular agent of choice in situations where flexible control of -blockade is necessary because of its rapid onset and short duration. Platia and colleagues 6 studied esmolol compared with verapamil in the short-term treatment of AF with RVR (heart rate of at least 120 beats per minute), demonstrating the value of -blocker use for. The authors reported that heart rate declined from 139 to 100 beats per minute (P.001) with esmolol and from 142 to 97 beats per minute (P.001) with verapamil. Moreover, the AFFIRM trial showed that more than 70% of patients achieved rate control with the use of -blockers, compared with 54% with the use of calcium channel blockers. 4 In patients for whom emergent is not indicated, the oral dosage forms of -blockers provide another alternative for their use. However, -blockers may not be the optimal choice for every patient, because -blockers can result in excessive bradycardia, lethargy, and shortness of breath. Although the effects of -blockers on 2 receptors are less pronounced, the effects of vasoconstriction on the vascular bed are still of concern because of the negative inotropic and chronotropic actions. In patients who experience bradycardia, hypotension, or heart block, -blockers are not the drug of choice. However, these adverse effects may be avoided by using -blockers with intrinsic sympathomimetic activity (ISA). These ISA agents work by exhibiting a low level of agonist activity at the site, while producing antagonistic effects. Pindolol and acebutolol are the most common agents used, at oral doses of 15 to 20 mg daily and 200 to 1200 mg once or twice daily, respectively. Although these agents are potential options, more trials and clinical evidence support the use of -blockers without ISA activity. Because -blockers without ISA have a long and successful history of use, they should be considered safe and effective options both in the emergent setting and for the long term to control rate. Calcium Channel Blockers Calcium channel blockers exhibit their mechanism of action by blocking the voltage-gated calcium channels in cardiac and blood vessels. Decreased intracellular calcium reduce s muscle contraction. Less contractility in the vascular smooth muscle can result in vasodilation, which can lead to afterload reduction (pressure against which the heart pumps). Afterload reduction ameliorates symptoms of ischemic heart disease and angina pectoris. Both verapamil and diltiazem are nondihydropyridine calcium-channel blocking options for patients with AF. Verapamil exerts most of its effects on the myocardium, with minimal afterload reduction, whereas diltiazem exhibits effects on both myocardium and vascular smooth muscle. The 2006 American College of Cardiology, American Heart Association, and European Society of Cardiology guidelines, Recommendation for Rate Control During Atrial Fibrillation, suggest the use of diltiazem in the instance of emergent AF. 7 The most efficacious and safe dose of diltiazem is still up for debate. According to these guidelines, 7 the current recommended dose of diltiazem to be given intravenously in emergency situations is a load of 0.25 mg/kg over 2 minutes. 7 A recent study suggests that lower doses of diltiazem are safer, producing less hypotension. In their study, Lee and colleagues 8 evaluated low-dose diltiazem in patients with AF with RVR. The 123
5 Drug Update AACN study compared 3 different doses of diltiazem in the emergent setting to control rate: low dose ( 0.2 mg/kg), standard dose (0.25 mg/kg), and high dose ( 0.3 mg/kg). The study reported no therapeutic benefits to using lower doses of diltiazem, but low doses were statistically significant for producing fewer hypotensive adverse effects (18%, 34.9%, and 41.7%, respectively; P.037). 8 Limitations to this study include its retrospective nature and small sample size. Perhaps differences in efficacy may have been noted if more patients had been compared. This low-dose strategy may be considered with clinical judgment for instances in which hypotension may lead to adverse outcomes. Emergent Rate Control Although long-term management of AF is the primary goal for patient care, emergent situations require a quick resolution on the basis of short-term goals. Long-term goals can be developed and adjusted later as needed. When a patient with signs of symptomatic AF arrives at the emergency department but is hemodynamically stable, the main goal for short-term management is. Rate control is achieved by the use of atrioventricular nodal-blocking a gents, which are the mainstay of therapy. Digoxin has been the favored drug in years past to control rate, but over time it has become a lesspopular option. Diltiazem has become a standard therapy and drug of choice for acute care settings. The study that brought diltiazem to the forefront compared intravenous diltiazem with intravenous digoxin in controlling acu te AF with RVR. The study used a dose of intravenous digoxin bolus of 0.25 mg initially and then another 0.25 mg at 30 minutes, compared with a diltiazem bolus of 0.25 mg/kg followed by a dose of 0.35 mg/kg and then a titratable infusion at a rate of 10 to 20 mg/h to maintain heart at a ventricular rate of less than 100 beats per minute. The authors concluded that for emergency management of rate control in AF, diltiazem is the drug of choice because of its rapid onset within 5 minutes (P.037). 9 The study used an unconventional dose of digoxin; the standard dose is usually 0.5 mg given intravenously once, followed by 0.25 mg every 6 hours for 2 doses. Diltiazem, although known to have negative inotropic effects, is thought to have fewer negative inotropic effects than verapamil. Effectiveness of diltiazem has been proven in previous studies, and because of its less significant inotropic effects compared with verapamil, diltiazem is considered a safe choice for nondihydropyridine calcium-channel blockade in the condition of acute AF. Intensity of Rate Control Today, the optimal level of is unknown. A recent study titled Rate Control Efficacy in Permanent Atrial Fibrillation (RACE II) by Van Gelder and colleagues 10 sought to determine the ideal heart rate for optimal rate control therapy. The study also evaluated the effect of preventing cardiovascular morbidity and mortality in patients diagnosed with permanent AF. Strict was defined as a resting heart rate of less than 80 beats per minute, and lenient heart rate was defined as a resting heart rate of less than 110 beats per minute. Patients were followed for a maximum of 3 years. The primary outcome was defined as a composite of stroke, death from cardiovascular events, hospitalization for heart failure, systemic embolism, bleeding, or life-threatening arrhythmic events. The primary outcome after 3 years was 12.9% in the lenient heart rate group and 14.9% in the strict-control group (P.001). In addition, more patients achieved successful (as defined per group) in the lenient heart rate group than in the strict-control group (97.7% vs 67%, respectively; P.001). 10 Worsening heart failure is of concern in patients with AF with preexisting heart failure because of venous pooling and increased preload. A limitation of RACE II is that worsening heart failure was not evaluated. However, the study population for both lenient and strict groups had similar incidences of heart failure at enrollment (3.8% vs 4.1%, respectively). 10 The study also included only low-risk patients who had not previously had a stroke and were physically active. The risk of primary outcome adverse events beyond that of 3 years is unknown. Although lenient heart may be a future direction for treatment goals, more studies are needed to confirm its place in therapy. However, the newly released 2011 American College of Cardiology, American Heart Association, and Heart Rhythm Society Focused Update on the Management of Patients With Atrial Fibrillation (Updating the 2006 Guideline): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines suggests that strict heart is unnecessary in all patients and lenient heart is 124
6 VOLUME 23 NUMBER 2 APRIL JUNE 2012 Drug Update more convenient for patients. 11 The consensus recommendation states that lenient heart rate control may be a good option for patients with permanently diagnosed AF with RVR. Conclusions Studies now confirm that is an accepted method of management of patients with AF with RVR. Pharmacological agents such as -blockers, digoxin, and nondihydropyridine calcium channel blockers provide patients with safe and efficacious options to control their symptoms and prevent adverse outcomes. -Blockers have a long-standing history of efficacy and safety demonstrated in both clinical experience and randomized controlled trials. Over time, digoxin has lost its popularity but still provides value in specific populations if appropriately monitored. In emergency situations, diltiazem is the nondihydropyridine calcium-channel blocker of choice. Furthermore, clinicians trying to treat patients with AF with RVR should consider a lenient heart approach rather than a strict-control approach, particularly in patients with permanent AF with RVR. REFERENCES 1. Naccarelli GV, Varker H, Lin J, et al. Increasing prevalence of atrial fibrillation and flutter in the United States. Am J Cardiol. 2009;104: Flegel KM, Shipley MJ, Rose G. Risk of stroke in nonrheumatic atrial fibrillation. Lancet. 1987;1: Olshansky B, Rosenfeld LE, Warner AL, et al. The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study: approaches to control rate in atrial fibrillation. J Am Coll Cardiol. 2004;43: Wattanasuwan N, Khan IA, Mehta NJ, et al. Acute ventricular in atrial fibrillation: IV combination of diltiazem and digoxin vs IV diltiazem alone. CHEST. 2001;119: Opie LH. Drugs and the heart. Lancet. 1980;1(8170): Platia EV, Michelson EL, Porterfield JK, et al. Esmolol versus verapamil in the acute treatment of atrial fibrillation or atrial flutter. Am J Cardiol. 1989;63: Fuster V, Ryden LE, Ainger RW, et al; and American College of Cardiology/American Heart Association Task Force on Practice Guidelines; European Society of Cardiology Committee for Practice Guidelines; European Heart Rhythm Association; Heart Rhythm Society. ACC/AHA/ ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006;114:e257 e Lee J, Kim K, Lee CC, et al. Low-dose dilt iazem in atrial fibrillation with rapid ventricular response. Am J Emerg Med. 2011;29(8): Schreck DM, Rivera AR, Tricarico VJ. Emergency management of atrial fibrillation and flutter: intravenous diltiazem versus intravenous digoxin. Ann Emerg Med. 1997;29: Van Gelder IC, Van Veldhuisen DJ, Crijns HJ, et al. Rate control efficacy in permanent atrial fibrillation: a comparison between lenient versus strict in patients with and without heart failure: background, aims, and design of RACE II. Am Heart J. 2006;152: Wann SL, Curtis AB, Crait T, et al ACCF/AHA/HRS focused update on the management of patients with atrial fibrillation (updating the 2006 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Heart Rhythm. 2011;8:
Recurrent AF: Choosing the Right Medication.
In the name of God Shiraz E-Medical Journal Vol. 11, No. 3, July 2010 http://semj.sums.ac.ir/vol11/jul2010/89015.htm Recurrent AF: Choosing the Right Medication. Basamad Z. * Assistant Professor, Department
More informationMedical management of CHF: A New Class of Medication. Al Timothy, M.D. Cardiovascular Institute of the South
Medical management of CHF: A New Class of Medication Al Timothy, M.D. Cardiovascular Institute of the South Disclosures Speakers Bureau for Amgen Background Chronic systolic congestive heart failure remains
More informationTreating AF: The Newest Recommendations. CardioCase presentation. Ethel s Case. Wayne Warnica, MD, FACC, FACP, FRCPC
Treating AF: The Newest Recommendations Wayne Warnica, MD, FACC, FACP, FRCPC CardioCase presentation Ethel s Case Ethel, 73, presents with rapid heart beating and mild chest discomfort. In the ED, ECG
More informationRATE VERSUS RHYTHM CONTROL OF ATRIAL FIBRILLATION: SPECIAL CONSIDERATION IN ELDERLY. Charles Jazra
RATE VERSUS RHYTHM CONTROL OF ATRIAL FIBRILLATION: SPECIAL CONSIDERATION IN ELDERLY Charles Jazra NO CONFLICT OF INTEREST TO DECLARE Relationship Between Atrial Fibrillation and Age Prevalence, percent
More informationAtrial Fibrillation 2014 How to Treat How to Anticoagulate. Allan Anderson, MD, FACC, FAHA Division of Cardiology
Atrial Fibrillation 2014 How to Treat How to Anticoagulate Allan Anderson, MD, FACC, FAHA Division of Cardiology Projection for Prevalence of Atrial Fibrillation: 5.6 Million by 2050 Projected number of
More informationHow to control atrial fibrillation in 2013 The ideal patient for a rate control strategy
How to control atrial fibrillation in 2013 The ideal patient for a rate control strategy L. Pison, MD Advances in Cardiac Arrhythmias and Great Innovations in Cardiology - Torino, September 28 th 2013
More informationAtrial Fibrillation Management Across the Spectrum of Illness
Disclosures Atrial Fibrillation Management Across the Spectrum of Illness NONE Barbara Birriel, MSN, ACNP-BC, FCCM The Pennsylvania State University Objectives AF Discuss the pathophysiology, diagnosis,
More informationATRIAL FIBRILLATION (RATE VS RHYTHM CONTROL)
ATRIAL FIBRILLATION (RATE VS RHYTHM CONTROL) By Prof. Dr. Helmy A. Bakr Mansoura Universirty 2014 AF Classification: Mechanisms of AF : Selected Risk Factors and Biomarkers for AF: WHY AF? 1. Atrial fibrillation
More informationCurrent Management of Atrial Fibrillation DISCLOSURES. Heart Beat Anatomy. I have no financial conflicts to disclose
Current Management of Atrial Fibrillation Mary Macklin, MSN, APRN Concord Hospital Cardiac Associates DISCLOSURES I have no financial conflicts to disclose Book Women: Fit at Fifty. A Guide to Living Long.
More informationANNE ARUNDEL MEDICAL CENTER CRITICAL CARE MEDICATION MANUAL DEPARTMENT OF NURSING AND PHARMACY. Guidelines for Use of Intravenous Isoproterenol
ANNE ARUNDEL MEDICAL CENTER CRITICAL CARE MEDICATION MANUAL DEPARTMENT OF NURSING AND PHARMACY Guidelines for Use of Intravenous Isoproterenol Major Indications Status Asthmaticus As a last resort for
More informationAtrial Fibrillation Cardiac rate control or rhythm control could be the key to AF therapy
Cardiac rate control or rhythm control could be the key to AF therapy Recent studies have proven that an option of pharmacologic and non-pharmacologic therapy is available to patients who suffer from AF.
More informationACLS PHARMACOLOGY 2011 Guidelines
ACLS PHARMACOLOGY 2011 Guidelines ADENOSINE Narrow complex tachycardias or wide complex tachycardias that may be supraventricular in nature. It is effective in treating 90% of the reentry arrhythmias.
More informationAtrial Fibrillation: Drugs, Ablation, or Benign Neglect. Robert Kennedy, MD October 10, 2015
Atrial Fibrillation: Drugs, Ablation, or Benign Neglect Robert Kennedy, MD October 10, 2015 Definitions 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary.
More informationDERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT of Atrial Fibrillation (AF)
DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT of Atrial Fibrillation (AF) Key priorities Identification and diagnosis Treatment for persistent AF Treatment for permanent AF Antithrombotic
More informationAtrial Fibrillation Peter Santucci, MD Revised May, 2008
Atrial Fibrillation Peter Santucci, MD Revised May, 2008 Atrial fibrillation (AF) is an irregular, disorganized rhythm characterized by a lack of organized mechanical atrial activity. The atrial rate is
More informationAtrial Fibrillation An update on diagnosis and management
Dr Arvind Vasudeva Consultant Cardiologist Atrial Fibrillation An update on diagnosis and management Atrial fibrillation (AF) remains the commonest disturbance of cardiac rhythm seen in clinical practice.
More informationACUTE ATRIAL FIBRILLATION TREATMENT IN THE SURGICAL PATIENT
DISCLAIMER: These guidelines were prepared by the Department of Surgical Education, Orlando Regional Medical Center. They are intended to serve as a general statement regarding appropriate patient care
More informationNEW ONSET ATRIAL FIBRILLATION IN THE SURGICAL PATIENT
DISCLAIMER: These guidelines were prepared by the Department of Surgical Education, Orlando Regional Medical Center. They are intended to serve as a general statement regarding appropriate patient care
More informationGUIDELINE 11.9 MANAGING ACUTE DYSRHYTHMIAS. (To be read in conjunction with Guideline 11.7 Post-Resuscitation Therapy in Adult Advanced Life Support)
AUSTRALIAN RESUSCITATION COUNCIL GUIDELINE 11.9 MANAGING ACUTE DYSRHYTHMIAS (To be read in conjunction with Guideline 11.7 Post-Resuscitation Therapy in Adult Advanced Life Support) The term cardiac arrhythmia
More informationAtrial Fibrillation in the ICU: Attempting to defend 4 controversial statements
Atrial Fibrillation in the ICU: Attempting to defend 4 controversial statements Salmaan Kanji, Pharm.D. The Ottawa Hospital The Ottawa Hospital Research Institute Conflict of Interest No financial, proprietary
More informationThe Emerging Atrial Fibrillation Epidemic: Treat It, Leave It or Burn It?
The Emerging Atrial Fibrillation Epidemic: Treat It, Leave It or Burn It? Indiana Chapter-ACC 17 th Annual Meeting Indianapolis, Indiana October 19, 2013 Deepak Bhakta MD FACC FACP FAHA FHRS CCDS Associate
More informationATRIAL FIBRILLATION RATE VS RHYTHM CONTROL NCVH BIRMINGHAM 2014
ATRIAL FIBRILLATION RATE VS RHYTHM CONTROL NCVH BIRMINGHAM 2014 Facts 4 million or so people have atrial fibrillation 16 billion dollars spent yearly in USA 30% of strokes attributable to AF and AFL 3-5
More informationACLS Cardiac Arrest Algorithm Neumar, R. W. et al. Circulation 2010;122:S729-S767
ACLS Cardiac Arrest Algorithm Neumar, R. W. et al. Circulation 2010;122:S729-S767 Copyright 2010 American Heart Association ACLS Cardiac Arrest Circular Algorithm Neumar, R. W. et al. Circulation 2010;122:S729-S767
More informationSeptic Shock: Pharmacologic Agents for Hemodynamic Support. Nathan E Cope, PharmD PGY2 Critical Care Pharmacy Resident
Septic Shock: Pharmacologic Agents for Hemodynamic Support Nathan E Cope, PharmD PGY2 Critical Care Pharmacy Resident Objectives Define septic shock and briefly review pathophysiology Outline receptor
More informationACCIDENT AND EMERGENCY DEPARTMENT/CARDIOLOGY
Care Pathway Triage category ATRIAL FIBRILLATION PATHWAY ACCIDENT AND EMERGENCY DEPARTMENT/CARDIOLOGY AF/ FLUTTER IS PRIMARY REASON FOR PRESENTATION YES NO ONSET SYMPTOMS OF AF./../ TIME DURATION OF AF
More informationManaging the Patient with Atrial Fibrillation
Pocket Guide Managing the Patient with Atrial Fibrillation Updated April 2012 Editor Stephen R. Shorofsky, MD, Ph.D. Assistant Editors Anastasios Saliaris, MD Shawn Robinson, MD www.hrsonline.org DEFINITION
More informationHow do you decide on rate versus rhythm control?
Heart Rhythm Congress 2014 How do you decide on rate versus rhythm control? Dr Ed Duncan Consultant Cardiologist & Electrophysiologist Define Rhythm Control DC Cardioversion Pharmacological AFFIRM study
More informationATRIAL FIBRILLATION IN THE 21 ST CENTURY TIMOTHY DOWLING, D.O. FAMILY PHYSICIAN
ATRIAL FIBRILLATION IN THE 21 ST CENTURY TIMOTHY DOWLING, D.O. FAMILY PHYSICIAN GOALS AND OBJECTIVES At The end of this talk you should understand: What is Atrial Fibrillation Causes of Atrial Fibrillation
More informationNational Medicines Information Centre
National Medicines Information Centre ST. JAMES S HOSPITAL DUBLIN 8 TEL 01-4730589 or 1850-727-727 FAX 01-4730596 www.nmic.ie THE CONTEMPORARY MANAGEMENT OF ATRIAL FIBRILLATION VOLUME 12 NUMBER 3 2006
More informationPRACTICAL APPROACH TO SVT. Graham C. Wong MD MPH Division of Cardiology Vancouver General Hospital University of British Columbia
PRACTICAL APPROACH TO SVT Graham C. Wong MD MPH Division of Cardiology Vancouver General Hospital University of British Columbia CONDUCTION SYSTEM OF THE HEART SA node His bundle Left bundle AV node Right
More informationManagement of Symptomatic Atrial Fibrillation
Management of Symptomatic Atrial Fibrillation John F. MacGregor, MD, FHRS Associate Medical Director, Cardiac Electrophysiology PeaceHealth St. Joseph Medical Center, Bellingham, WA September 18, 2015
More information9/5/14. Objectives. Atrial Fibrillation (AF)
Novel Anticoagulation for Prevention of Stroke in Patients with Atrial Fibrillation Objectives 1. Review current evidence on use of warfarin in individuals with atrial fibrillation 2. Compare the three
More informationPresenter Disclosure Information
2:15 3 pm Managing Arrhythmias in Primary Care Presenter Disclosure Information The following relationships exist related to this presentation: Raul Mitrani, MD, FACC, FHRS: Speakers Bureau for Medtronic.
More informationManagement of ATRIAL FIBRILLATION. in general practice. 22 BPJ Issue 39
Management of ATRIAL FIBRILLATION in general practice 22 BPJ Issue 39 What is atrial fibrillation? Atrial fibrillation (AF) is the most common cardiac arrhythmia encountered in primary care. It is often
More informationCardiovascular System & Its Diseases. Lecture #4 Heart Failure & Cardiac Arrhythmias
Cardiovascular System & Its Diseases Lecture #4 Heart Failure & Cardiac Arrhythmias Dr. Derek Bowie, Department of Pharmacology & Therapeutics, Room 1317, McIntyre Bldg, McGill University derek.bowie@mcgill.ca
More informationTABLE 1 Clinical Classification of AF. New onset AF (first detected) Paroxysmal (<7 days, mostly < 24 hours)
Clinical Practice Guidelines for the Management of Patients With Atrial Fibrillation Deborah Ritchie RN, MN, Robert S Sheldon MD, PhD Cardiovascular Research Group, University of Calgary, Alberta Partly
More informationCardioversion for. Atrial Fibrillation. Your Heart s Electrical System Cardioversion Living with Atrial Fibrillation
Cardioversion for Atrial Fibrillation Your Heart s Electrical System Cardioversion Living with Atrial Fibrillation When You Have Atrial Fibrillation You ve been told you have a heart condition called atrial
More informationSTROKE PREVENTION IN ATRIAL FIBRILLATION. TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: ABBREVIATIONS: BACKGROUND:
STROKE PREVENTION IN ATRIAL FIBRILLATION TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: To guide clinicians in the selection of antithrombotic therapy for the secondary prevention
More informationAnticoagulants in Atrial Fibrillation
Anticoagulants in Atrial Fibrillation Starting and Stopping Them Safely Carmine D Amico, D.O. Overview Learning objectives Introduction Basic concepts Treatment strategy & options Summary 1 Learning objectives
More informationAtrial Fibrillation The Basics
Atrial Fibrillation The Basics Family Practice Symposium Tim McAveney, M.D. 10/23/09 Objectives Review the fundamentals of managing afib Discuss the risks for stroke and the indications for anticoagulation
More informationAtrial Fibrillation: Rate Control Strategies
Atrial Fibrillation: Rate Control Strategies Olshansky, Brian Sbaity, Salam Summary The safest long-term management strategy for elderly patients with persistent or permanent and some patients with paroxysmal
More informationProtocol for the management of atrial fibrillation in primary care
Protocol for the management of atrial fibrillation in primary care Protocol for the management of atrial fibrillation in primary care Contents Page no Definition 2 Classification of AF 2 3 Identification
More informationPractical Rate and Rhythm Management of Atrial Fibrillation
Practical Rate and Rhythm Management of Atrial Fibrillation pocket guide UPDATED FEBRUARY 2013 Adapted from the ACCF/AHA/HRS 2011 Focused Updates Incorporated into the ACC/AHA/ESC Guidelines for the Management
More informationCrash Cart Drugs Drugs used in CPR. Dr. Layla Borham Professor of Clinical Pharmacology Umm Al Qura University
Crash Cart Drugs Drugs used in CPR Dr. Layla Borham Professor of Clinical Pharmacology Umm Al Qura University Introduction A list of the drugs kept in the crash carts. This list has been approved by the
More informationNovartis Gilenya FDO Program Clinical Protocol and Highlights from Prescribing Information (PI)
Novartis Gilenya FDO Program Clinical Protocol and Highlights from Prescribing Information (PI) Highlights from Prescribing Information - the link to the full text PI is as follows: http://www.pharma.us.novartis.com/product/pi/pdf/gilenya.pdf
More informationAtrial fibrillation. Quick reference guide. Issue date: June 2006. The management of atrial fibrillation
Quick reference guide Issue date: June 2006 Atrial fibrillation The management of atrial fibrillation Developed by the National Collaborating Centre for Chronic Conditions Contents Contents Patient-centred
More informationAntiplatelet and Antithrombotics From clinical trials to guidelines
Antiplatelet and Antithrombotics From clinical trials to guidelines Ashraf Reda, MD, FESC Prof and head of Cardiology Dep. Menofiya University Preisedent of EGYBAC Chairman of WGLVR One of the big stories
More informationHow do you decide on rate versus rhythm control?
How do you decide on rate versus rhythm control? Dr. Mark O Neill Consultant Cardiologist & Electrophysiologist Assumptions Camm et al. EHJ 2010;Sept 25 epub Choice of strategy: Criteria for consideration
More informationCardiac Arrest VF/Pulseless VT Learning Station Checklist
Cardiac Arrest VF/Pulseless VT Learning Station Checklist VF/VT 00 American Heart Association Adult Cardiac Arrest Shout for Help/Activate Emergency Response Epinephrine every - min Amiodarone Start CPR
More informationA randomized, controlled trial comparing the efficacy of carvedilol vs. metoprolol in the treatment of atrial fibrillation
A randomized, controlled trial comparing the efficacy of carvedilol vs. metoprolol in the treatment of atrial fibrillation Gabriel Sayer Lay Abstract: Atrial fibrillation is a common form of irregular,
More informationWho, when and how to rate control for atrial fibrillation Michiel Rienstra and Isabelle C. Van Gelder
Who, when and how to rate control for atrial fibrillation Michiel Rienstra and Isabelle C. Van Gelder Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen,
More informationAtrial Fibrillation Based on ESC Guidelines. Moshe Swissa MD Kaplan Medical Center
Atrial Fibrillation Based on ESC Guidelines Moshe Swissa MD Kaplan Medical Center Epidemiology AF affects 1 2% of the population, and this figure is likely to increase in the next 50 years. AF may long
More informationAtrial & Junctional Dysrhythmias
Atrial & Junctional Dysrhythmias Atrial & Junctional Dysrhythmias Atrial Premature Atrial Complex Wandering Atrial Pacemaker Atrial Tachycardia (ectopic) Multifocal Atrial Tachycardia Atrial Flutter Atrial
More informationNew Treatments for Stroke Prevention in Atrial Fibrillation. John C. Andrefsky, MD, FAHA NEOMED Internal Medicine Review course May 5 th, 2013
New Treatments for Stroke Prevention in Atrial Fibrillation John C. Andrefsky, MD, FAHA NEOMED Internal Medicine Review course May 5 th, 2013 Classification Paroxysmal atrial fibrillation (AF) Last < 7
More informationAtrial fibrillation (AF) care pathways. for the primary care physicians
Atrial fibrillation (AF) care pathways for the primary care physicians by University of Minnesota Physicians Heart, October, 2011 Evaluation by the primary care physician: 1. Comprehensive history and
More informationAdding IV Amiodarone to the EMS Algorithm for Cardiac Arrest Due to VF/Pulseless VT
Adding IV Amiodarone to the EMS Algorithm for Cardiac Arrest Due to VF/Pulseless VT Introduction Before the year 2000, the traditional antiarrhythmic agents (lidocaine, bretylium, magnesium sulfate, procainamide,
More informationINFORMATION FOR PATIENTS AND FAMILIES A Patient s Guide to Living with Atrial Fibrillation
INFORMATION FOR PATIENTS AND FAMILIES A Patient s Guide to Living with Atrial Fibrillation 30 Bond Street, Toronto, ON M5B 1W8 Canada 416.864.6060 stmichaelshospital.com Form No. XXXXX Dev. XX/XXXX GOALS
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE. Health Technology Appraisal. Drugs for the treatment of pulmonary arterial hypertension
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Health Technology Appraisal Drugs for the treatment of Remit / Appraisal objective: Final scope To appraise the clinical and cost effectiveness of
More information1/7/2012. Objectives. Epidemiology of Atrial Fibrillation(AF) Stroke in AF. Stroke Risk Stratification in AF
Objectives Atrial Fibrillation and Prevention of Thrombotic Complications: Therapeutic Update Andrea C. Flores Pharm.D Pharmacy Resident at the Miami VA Healthcare System Review the epidemiology, pathophysiology
More informationATRIAL FIBRILLATION: Scope of the Problem. October 2015
ATRIAL FIBRILLATION: Scope of the Problem October 2015 Purpose of the Presentation Review the worldwide incidence and prognosis associated with atrial fibrillation (AF) Identify the types of AF, clinical
More informationAtrial Fibrillation Centre
About this guide We have prepared this guide to help you to: learn about atrial fibrillation manage atrial fibrillation and reduce the risk of stroke find out about medicines and other treatment options
More informationAddendum to the Guideline on antiarrhythmics on atrial fibrillation and atrial flutter
22 July 2010 EMA/CHMP/EWP/213056/2010 Addendum to the Guideline on antiarrhythmics on atrial fibrillation and atrial flutter Draft Agreed by Efficacy Working Party July 2008 Adoption by CHMP for release
More informationAtrial Fibrillation. Information for you, and your family, whänau and friends. Published by the New Zealand Guidelines Group
Atrial Fibrillation Information for you, and your family, whänau and friends Published by the New Zealand Guidelines Group CONTENTS Introduction 1 The heart 2 What is atrial fibrillation? 3 How common
More informationAn important challenge in modern medicine is to blend
THE JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION Patient-Centered Management of Atrial Fibrillation: Applying Evidence-Based Care to the Individual Patient Eric D. Good, DO Felix J. Rogers, DO Atrial
More informationHypertension and Heart Failure Medications. Dr William Dooley
Hypertension and Heart Failure Medications Dr William Dooley Plan Heart Failure Acute vs. chronic Mx Hypertension Common drugs used Method of action Choice of medications Heart Failure Aims; Short term:
More informationAdvantages of rate control Disadvantage of rate control Advantages of rhythm control Disadvantages of rhythm control
TABLE OF CONTENTS Atrial fibrillation: rate versus rhythm control AFFIRM and RACE trials 1 B-type natriuretic peptide a useful diagnostic marker for heart failure? 3 P& T Committee Formulary Action 5 Enoxaparin
More informationTHE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT
THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT Stroke Prevention in Atrial Fibrillation Gregory Albers, M.D. Director Stanford Stroke Center Professor of Neurology and Neurological
More informationThe Effect of Digoxin on Ventricular Rate in Emergency Department
Advanced Pharmaceutical Bulletin,2012, 2(2), 201-205 doi: 10.5681/apb.2012.031 http://apb.tbzmed.ac.ir/ A Comparison of and for Heart Rate Control in Atrial Fibrillation Mohammad Afzali Moghadam 1, Maryam
More informationBios 6648: Design & conduct of clinical research
Bios 6648: Design & conduct of clinical research Section 1 - Specifying the study setting and objectives 1. Specifying the study setting and objectives 1.0 Background Where will we end up?: (a) The treatment
More informationTreatments to Restore Normal Rhythm
Treatments to Restore Normal Rhythm In many instances when AF causes significant symptoms or is negatively impacting a patient's health, the major goal of treatment is to restore normal rhythm and prevent
More informationHeart Failure: Diagnosis and Treatment
Heart Failure: Diagnosis and Treatment Approximately 5 million people about 2 percent of the U.S. population are affected by heart failure. Diabetes affects 20.8 million Americans and 65 million Americans
More informationAnticoagulation before and after cardioversion; which and for how long
Anticoagulation before and after cardioversion; which and for how long Sameh Samir, MD Cardiovascular medicine dept. Tanta faculty of medicine Atrial fibrillation goals of management Identify and treat
More informationPalpitations & AF. Richard Grocott Mason Consultant Cardiologist THH NHS Foundation Trust & Royal Brompton & Harefield NHS Foundation Trust
Palpitations & AF Richard Grocott Mason Consultant Cardiologist THH NHS Foundation Trust & Royal Brompton & Harefield NHS Foundation Trust Palpitations Frequent symptom Less than 50% associated with arrhythmia
More informationInotropes/Vasoactive Agents Hina N. Patel, Pharm.D., BCPS Cathy Lawson, Pharm.D., BCPS
Inotropes/Vasoactive Agents Hina N. Patel, Pharm.D., BCPS Cathy Lawson, Pharm.D., BCPS 1. Definition -an agent that affects the contractility of the heart -may be positive (increases contractility) or
More information2014: nowadays the one shot technologies and the injectable monitor allow a wide and complete AF patient management. Why shouldn t we use them?
2014: nowadays the one shot technologies and the injectable monitor allow a wide and complete AF patient management. Why shouldn t we use them? Gaetano Senatore DIVISION OF CARDIOLOGY HOSPITAL OF CIRIE
More informationAtrial Fibrillation. Management of Patients With. ACCF/AHA Pocket Guideline
ACCF/AHA Pocket Guideline Management of Patients With Atrial Fibrillation (Adapted from the 2006 ACC/AHA/ESC Guideline and the 2011 ACCF/AHA/HRS Focused Updates) 2011 American College of Cardiology Foundation
More informationUpdate on Small Animal Cardiopulmonary Resuscitation (CPR)- is anything new?
Update on Small Animal Cardiopulmonary Resuscitation (CPR)- is anything new? DVM, DACVA Objective: Update on the new Small animal guidelines for CPR and a discussion of the 2012 Reassessment Campaign on
More informationClinical Guideline for the Management of Pot Operative Atrial Fibrillation
Clinical Guideline for the Management of Pot Operative Atrial Fibrillation 1. Aim/Purpose of this Guideline 1.1. Atrial Fibrillation is the most common cardiac arrhythmia with a prevalence of around 0.5%
More informationMedical Tourism - Atrial Fibrillation and the Risk of Heart Failure
Anti-Arrhythmic Drugs for Atrial Fibrillation Atrial Fibrillation Association: Summary of Drug Therapy Options 2012 An expert update summary report on anti-arrhythmic therapy in the UK www.afa.org.uk www.heartofaf.org
More information8 Peri-arrest arrhythmias
8 Peri-arrest arrhythmias Introduction Cardiac arrhythmias are relatively common in the peri-arrest period. They are common in the setting of acute myocardial infarction and may precipitate ventricular
More informationTOP 5. The term cardiac arrhythmia encompasses all cardiac. Arrhythmias in Dogs & Cats. Sinus Arrhythmia. TOP 5 Arrhythmias Seen in Dogs & Cats
Top 5 ardiology Peer reviewed TOP 5 rrhythmias in Dogs & ats shley Jones, DVM mara Estrada, DVM, DVIM (ardiology) University of Florida The term cardiac arrhythmia encompasses all cardiac rhythms other
More informationThe heart then repolarises (or refills) in time for the next stimulus and contraction.
Atrial Fibrillation BRIEFLY, HOW DOES THE HEART PUMP? The heart has four chambers. The upper chambers are called atria. One chamber is called an atrium, and the lower chambers are called ventricles. In
More informationSTROKE PREVENTION IN ATRIAL FIBRILLATION
STROKE PREVENTION IN ATRIAL FIBRILLATION OBJECTIVE: To guide clinicians in the selection of antithrombotic therapy for the secondary prevention of ischemic stroke and arterial thromboembolism in patients
More informationTherapeutic Approach in Patients with Diabetes and Coronary Artery Disease
Home SVCC Area: English - Español - Português Therapeutic Approach in Patients with Diabetes and Coronary Artery Disease Martial G. Bourassa, MD Research Center, Montreal Heart Institute, Montreal, Quebec,
More informationQuiz 4 Arrhythmias summary statistics and question answers
1 Quiz 4 Arrhythmias summary statistics and question answers The correct answers to questions are indicated by *. All students were awarded 2 points for question #2 due to no appropriate responses for
More informationNew Anticoagulation Options for Stroke Prevention in Atrial Fibrillation. Joy Wahawisan, Pharm.D., BCPS April 25, 2012
New Anticoagulation Options for Stroke Prevention in Atrial Fibrillation Joy Wahawisan, Pharm.D., BCPS April 25, 2012 Stroke in Atrial Fibrillation % Stroke 1991;22:983. Age Range (years) CHADS 2 Risk
More informationMilwaukee School of Engineering Gerrits@msoe.edu. Case Study: Factors that Affect Blood Pressure Instructor Version
Case Study: Factors that Affect Blood Pressure Instructor Version Goal This activity (case study and its associated questions) is designed to be a student-centered learning activity relating to the factors
More informationNICE clinical guideline 180: Atrial fibrillation Prescribing and medicines optimisation issues
NICE clinical guideline 180: Atrial fibrillation Prescribing and medicines optimisation issues Andy Hutchinson Medicines Education Technical Adviser NICE Medicines and Prescribing Centre Note: this is
More informationVasopressors. Judith Hellman, M.D. Associate Professor Anesthesia and Perioperative Care University of California, San Francisco
Vasopressors Judith Hellman, M.D. Associate Professor Anesthesia and Perioperative Care University of California, San Francisco Overview Define shock states Review drugs commonly used to treat hypotension
More informationResults Study population
Clinical assessment of clonidine in the treatment of new-onset rapid atrial fibrillation: A prospective, randomized clinical trial Christopher S. Simpson, MD, FRCPC, FACC, a William A. Ghali, MD, MPH,
More informationEssential facts for med-surg nurses
Emergency cardiac drugs: Essential facts for med-surg nurses Emergencies on a med-surg unit can be daunting. By Ira Gene Reynolds, MSNEd, RN, PCCN-CMC IN THE HOSPITAL SETTING, emergencies typically occur
More informationTraditionally, the goal of atrial fibrillation (AF)
358 Clinical Pharmacist November 2010 Vol 2 Treatment of atrial fibrillation usually involves controlling ventricular rate or restoring sinus rhythm. Equally important is thromboembolic risk assessment
More informationSecondary Stroke Prevention Luke Bradbury, MD 10/4/14 Fall WAPA Conferfence
Guidelines Secondary Stroke Prevention Luke Bradbury, MD 10/4/14 Fall WAPA Conferfence Stroke/TIA Nearly 700,000 ischemic strokes and 240,000 TIAs every year in the United States Currently, the risk for
More informationThe author has no disclosures
Mary Bradbury, PharmD, BCPS Clinical Pharmacy Specialist, Cardiac Surgery September 18, 2012 Mary.bradbury@inova.org This presentation will discuss unlabeled and investigational use of products The author
More informationUniversitätsklinik für Kardiologie. Test. Thomas M. Suter Akute Herzinsuffizienz Diagnostik und Therapie thomas.suter@insel.ch 1
Test Thomas M. Suter Akute Herzinsuffizienz Diagnostik und Therapie thomas.suter@insel.ch 1 Heart Failure - Definition European Heart Journal (2008) 29, 2388 2442 Akute Herzinsuffizienz Diagnostik und
More informationSign up to receive ATOTW weekly - email wfsahq@anaesthesiologists.org
ATRIAL FIBRILLATION (AF). PERI-OPERATIVE MANAGEMENT FOR NON-CARDIAC SURGERY ANAESTHESIA TUTORIAL OF THE WEEK 307 28 th APRIL 2014 Dr J Sokhi Southend University Hospital, UK Professor J Kinnear Southend
More informationDorset Cardiac Centre
P a g e 1 Dorset Cardiac Centre Patients with Atrial Fibrillation/Flutter undergoing DC Cardioversion or Ablation procedures- Guidelines for Novel Oral Anti-coagulants (NOACS) licensed for this use February
More informationManagement of Atrial Fibrillation in the Emergency Department
Management of Atrial Fibrillation in the Emergency Department Ref: Emergency Medicine Clinics of North America, 2005 Introduction AfAf is most common cardiac arrhythmia Sequelae: : range from none to devastating:
More informationIschemic Heart Disease: Angina Pectoris
Ischemic Heart Disease: Angina Pectoris Robert J. Straka, Pharm.D. FCCP Associate Professor University of Minnesota College of Pharmacy Minneapolis, Minnesota, USA strak001@umn.edu Learning Objectives
More informationPharmacotherapy Options in Atrial Fibrillation: Focus on Vernakalant
REVIEW Pharmacotherapy Options in Atrial Fibrillation: Focus on Vernakalant Judy W.M. Cheng 1 and Iwona Rybak 2 1 Professor of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences and
More information