An EXCITING NEW guideline from @escardio at #ESCCongress on Atrial Fibrillation. It’s a long read of 126 but enjoyable! Here are my top tips from this guideline…#epeeps Link: bit.ly/2YRdX8S @mmamas1973 @pash22 @Hragy @DrMarthaGulati @ErinMichos @AnastasiaSMihai /THEAD 
FOCUS is on CONFIRMING AF (12 lead >30s) and CHARACTERISING it…
The 4S….
Stroke Risk…
Symptom Severity…
Severity Burden of AF
Substrate of AF
@KTamirisaMD @StavrosStavrak1 @StavrosDrakos @JonathanBehar @bogdienache @mencardio
#ESCCongress /3
The 4S….
Stroke Risk…
Symptom Severity…
Severity Burden of AF
Substrate of AF
@KTamirisaMD @StavrosStavrak1 @StavrosDrakos @JonathanBehar @bogdienache @mencardio
#ESCCongress /3
AF ESC GUIDELINE Tweetorial
Stroke Risk – Simple – CHA2DS2-VASc Score
& HAS-BLED, to stratify bleeding
Symptom severity- Use the EHRA symptom scale
Burden- paroxysmal, persistent, permanent and if paroxysmal how frequently
Substrate of AF- comorbidities #ESCCongress /4
Stroke Risk – Simple – CHA2DS2-VASc Score
& HAS-BLED, to stratify bleeding
Symptom severity- Use the EHRA symptom scale
Burden- paroxysmal, persistent, permanent and if paroxysmal how frequently
Substrate of AF- comorbidities #ESCCongress /4
AF ESC GUIDELINE Tweetorial #ESCCongress /5
Clear message about identification of AF on Atrial High Rate episodes on devices (pacemakers, implantable loop recorders) … Need to see an one lead ECG & there too need >30s. If not able to get this then close monitoring @ecgrhythms
Clear message about identification of AF on Atrial High Rate episodes on devices (pacemakers, implantable loop recorders) … Need to see an one lead ECG & there too need >30s. If not able to get this then close monitoring @ecgrhythms
AF ESC GUIDELINE Tweetorial #ESCCongress /6
AF is common… More prevalent in Elderly, Men, Caucasian, lower socioeconomic calss, those with increased cardiometabolic risks and portends an adverse prognosis
@HeartOTXHeartMD @DrToniyaSingh @rahatheart1 @CardioIAN @RafKotronias
AF is common… More prevalent in Elderly, Men, Caucasian, lower socioeconomic calss, those with increased cardiometabolic risks and portends an adverse prognosis
@HeartOTXHeartMD @DrToniyaSingh @rahatheart1 @CardioIAN @RafKotronias
AF ESC GUIDELINE Tweetorial #ESCCongress /6
AF is only part of the spectrum of disease for that individual…Everything else needs to be managed too…
Coronary disease
Hypertension
Obesity
Lack of exercise
Diabetes
Kidney failure
at least 6 & 12 month review initially @duanepinto
AF is only part of the spectrum of disease for that individual…Everything else needs to be managed too…
Coronary disease
Hypertension
Obesity
Lack of exercise
Diabetes
Kidney failure
at least 6 & 12 month review initially @duanepinto
AF ESC GUIDELINE Tweetorial #ESCCongress /7
New start like the ABC!
A-Anticoagulation – Easy CHA2DS2-VASc score – anticoagulate any man≥1 £ woman≥2 (remember sex is risk modifier not a risk predictor, so I cannot see how women can have score=1 (quoted in the algorithm below)
New start like the ABC!
A-Anticoagulation – Easy CHA2DS2-VASc score – anticoagulate any man≥1 £ woman≥2 (remember sex is risk modifier not a risk predictor, so I cannot see how women can have score=1 (quoted in the algorithm below)
AF ESC GUIDELINE Tweetorial #ESCCongress /8
Still on A... Check Bleeding risk – HAS-BLED if >3 aim to optimise any reversible conditions… do NOT withhold anticoagulation even if HAS-BLED is high.
@wordfinga @mancunianmedic @duanepinto @SaludHEALTHinfo @pabeda1 @VietHeartPA
Still on A... Check Bleeding risk – HAS-BLED if >3 aim to optimise any reversible conditions… do NOT withhold anticoagulation even if HAS-BLED is high.
@wordfinga @mancunianmedic @duanepinto @SaludHEALTHinfo @pabeda1 @VietHeartPA
AF ESC GUIDELINE Tweetorial #ESCCongress /8
B – Better symptom control – rate controlled preferred! Rhythm controlled also suggested… and EMPHASIS on decision being PATIENT centred
C – cardiovascular risk management – put simple… manage all other cardiac conditions and risk
B – Better symptom control – rate controlled preferred! Rhythm controlled also suggested… and EMPHASIS on decision being PATIENT centred
C – cardiovascular risk management – put simple… manage all other cardiac conditions and risk
AF ESC GUIDELINE Tweetorial #ESCCongress /9
Never forget Adherence… it is crucial!
@DrRajivsankar @corinne8154 @novitskiynic @MichaelPapadak2 @DrMichail @psmedic @drahmadzubair @AnkurGuptaMD @timir_paul @hannahcvimaging @hannahzr @SSharmacardio @ShraboniGhosal @docjohnnyg
Never forget Adherence… it is crucial!
@DrRajivsankar @corinne8154 @novitskiynic @MichaelPapadak2 @DrMichail @psmedic @drahmadzubair @AnkurGuptaMD @timir_paul @hannahcvimaging @hannahzr @SSharmacardio @ShraboniGhosal @docjohnnyg
AF ESC GUIDELINE Tweetorial #ESCCongress /10
Can we predict the future of AF? We know that short episodes become longer and then paroxysmal AF becomes permanent… but here… #whycmr gets a central SPOT! Even as a CMR enthusiast I don't think many centres can identify LA fibrosis
Can we predict the future of AF? We know that short episodes become longer and then paroxysmal AF becomes permanent… but here… #whycmr gets a central SPOT! Even as a CMR enthusiast I don't think many centres can identify LA fibrosis
AF ESC GUIDELINE Tweetorial #ESCCongress /11
And on Atrial High Rate Episodes… we will be seeing a lot more of this… but is a 31s AF so different to 28s? We know AF is progressive so I believe more emphasis should be put on the CHA2DS2-VASc score than duration @DrPascalMeier
And on Atrial High Rate Episodes… we will be seeing a lot more of this… but is a 31s AF so different to 28s? We know AF is progressive so I believe more emphasis should be put on the CHA2DS2-VASc score than duration @DrPascalMeier
AF ESC GUIDELINE Tweetorial #ESCCongress /12
And I think I missed some key messages in the flow of the tweetorial!
Heart rate - don't go too low... <110 bpm seems ok
@HolgerNef @PaulDendale @ProfessorHalle @PMarquesVidal @majalisalochen1 @DrTiberi @TharushaGunawa4 @justvick
And I think I missed some key messages in the flow of the tweetorial!
Heart rate - don't go too low... <110 bpm seems ok
@HolgerNef @PaulDendale @ProfessorHalle @PMarquesVidal @majalisalochen1 @DrTiberi @TharushaGunawa4 @justvick
AF ESC GUIDELINE Tweetorial #ESCCongress /END -1
Rhythm control or Cardioversion? Putting the patient in control... unless rhythm strategy really fails...
@HEARTinMagnet @hvanspall @heartdoc45 @HanCardiomd @Izanagi_no_mi_ @CJohnston1903 @LopezOpitz @Vilavaite @Kfarooqi
Rhythm control or Cardioversion? Putting the patient in control... unless rhythm strategy really fails...
@HEARTinMagnet @hvanspall @heartdoc45 @HanCardiomd @Izanagi_no_mi_ @CJohnston1903 @LopezOpitz @Vilavaite @Kfarooqi
AF ESC GUIDELINE Tweetorial #ESCCongress / THE END
In short...get the right diagnosis, put the patients on the right management for AF and other conditions (including lifestyle, exercise, nutrition) then rate control-->rhythm control & work as a partnership @exerciseworks
In short...get the right diagnosis, put the patients on the right management for AF and other conditions (including lifestyle, exercise, nutrition) then rate control-->rhythm control & work as a partnership @exerciseworks
