1 / 35

Medical Treatment for Atrial Fibrillation Prevention Role of Renin – Angiotensin Antagonists

Medical Treatment for Atrial Fibrillation Prevention Role of Renin – Angiotensin Antagonists Dr. V. Witzling. Prevalence of Atrial Fibrillation In general population. Atrial fibrillation : Paroxysmal Persistent Chronic. Goals of treatment : Prevention

maeko
Download Presentation

Medical Treatment for Atrial Fibrillation Prevention Role of Renin – Angiotensin Antagonists

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Medical Treatment for Atrial Fibrillation Prevention Role of Renin – Angiotensin Antagonists Dr. V. Witzling

  2. Prevalence of Atrial Fibrillation In general population

  3. Atrial fibrillation: • Paroxysmal • Persistent • Chronic

  4. Goals of treatment : • Prevention • Reduce the risk of thromboembolism • Control symptoms : • Rate control • Rhythm control

  5. Treatment : • Acute management : • Electrical cardioversion • Chemical cardioversion • Rate control

  6. Long term management : • Rate control • Drugs • AV nodal ablation and permanent pacing • Rhythm control • Drugs • Catheter ablation • Maze procedure

  7. Current treatment strategies are far from optimal • Anticoagulation - expensive and has its risk • Anti-arrhythmic drugs – imperfect and with side effects • Ablation – complex and with potential for major complications

  8. Antiarrhythmic Drugs: Efficacy MaintainingNSR ≥6 Months

  9. Safety issues – ablation • Pulmonary Vein Stenosis • Cerebrovascular accident (CVA) • Bezold-Jarisch response (?RSPV) • Phrenic nerve injury (RSPV) • Cardiac tamponade • Pulmonary parenchymal hemorrhage and bronchial vein damage • Atrioesophageal fistula formation

  10. Evidence of the importance of the RAAS for cardiovascular disease is partly attributable to the finding that : • renin activity predicts cardiovascular events • Inhibition of the system improves cardiovascular morbidity and mortality • ACEI’s and ARBs

  11. New research direction • to target the atrial fibrillation substrate • to examine if drugs can produce atrial structural and electrical remodeling • whether this results in clinically significant reduction of atrial fibrillation burden

  12. Relation RAAS – AF : • Studies in various patient populations with AF as secondary end point • Hypertentsion • Congestive heart failure • Post myocardial infarction

  13. Hypertension – LIFE study • > 9000 patients with hypertension and LVH by ECG • Losartan vs. Atenolol • Primary endpoint ( death,MI and stroke ) significantly reduced in the losartan arm

  14. LIFE: New Onset Atrial Fibrillation

  15. Heart Failure – Val-HeFT study • > 5000 patients, in NYHA class II-IV and with a LVEF < 40% • Valsartan vs. placebo • Significant reduction of combined mortality and morbidity from heart failure in the valsartan arm

  16. VALHeFT

  17. Post MI – TRACE study • > 1700 patients, 2 to 6 days after MI, with LVEF≤35% • Trandolapril vs. placebo • Primary endpoint ( death ) reduced significantly in the trandolapril arm

  18. Clinical trials with AF as primary end point: • Madrid • Ueng

  19. Conclusion • The initial basic science and clinical trial data suggests that modulation of the RAS system may be a treatment for preventing atrial fibrillation • Points to be clarified : • Do these drugs have a clinically meaningful impact on atrial fibrillation? • If there is an impact, is it similar in all atrial fibrillation patients? • Do ACEI’s and ARBs have similar benefits?

  20. Ongoing prospective studies

  21. Conclusion • Currently there is no enough data to recommend the use of ACEI’s and ARBs in routine clinical practice for prevention of atrial fibrillation. • Sufficient data for the European Society of Hypertension and the European Society of Cardiology to recommend ACEI or ARB first line treatment for hypertensive patients that also have recurrent PAF ( guidelines for hypertension 2007)

More Related