Paper Information

Title: 

THE BEST PRACTICES IN TREATMENT OF ARRHYTHMIA

Type: SPEECH
Author(s): ORAII SAEED*
 
 *CARDIOLOGIST, INTERVENTIONAL ELECTRO PHYSIOLOGIST TEHRAN ARRHYTHMIA CENTER
 
Name of Seminar: 2ND NATIONAL AND 1ST INTERNATIONAL CONFERENCE FOR BEST PRACTICES OF PRIMARY HEALTH CARE
Type of Seminar:  CONFERENCE
Sponsor:  NORTH KHORASAN UNIVERSITY OF MEDICAL SCIENCES
Date:  2012Volume 2
 
 
Abstract: 

THE TWO MOST COMMON COMMUNITY-WIDE ARRHYTHMIA RELATED HEALTH ISSUES ARE ATRIAL FIBRILLATION (AF) AND SUDDEN CARDIAC DEATH. THE IRREGULARITY OF HEART RHYTHM ASSOCIATED WITH AF WAS FIRST DESCRIBED BY DR. HERING IN 1903. AF IS BY FAR THE MOST COMMON SUSTAINED ARRHYTHMIA DIAGNOSED AND TREATED BY PHYSICIANS. THE CURRENT ESTIMATE OF THE PREVALENCE OF AF IN THE DEVELOPED WORLD IS APPROXIMATELY 1.5–2% OF THE GENERAL POPULATION. APPROXIMATELY 500,000 PATIENTS IN THE UK AND 2.5 MILLION PEOPLE IN US (2010) AND OVER 5 MILLION IN WESTERN EUROPE HAVE AF AND THE LIFETIME RISK OF DEVELOPING AF IS ESTIMATED TO BE AROUND 25% IN THOSE WHO HAVE REACHED THE AGE OF 40. THE PREVALENCE OF AF INCREASES WITH AGE I. E. FROM 0.5% AT 40–50 YEARS TO 5–15% AT 80 YEARS. IT IS ESTIMATED THAT THE NUMBER OF PERSONS WITH AF IN THE UNITED STATES WILL INCREASE THREE TO FOUR-FOLD FROM 2.6 MILLION IN 2010 TO EPIDEMIC PROPORTIONS OF 12-16 MILLION IN 2050 AND THIS CAN BE TRULY CONSIDERED AN EPIDEMIOLOGICAL TIME BOMB. HEALTH ISSUES RELATED TO AF INCLUDE A DOUBLED DEATH RATE, FREQUENT HOSPITALIZATIONS, IMPAIRED QUALITY OF LIFE AND EXERCISE CAPACITY, LEFT VENTRICULAR DYSFUNCTION, COGNITIVE DYSFUNCTION AND MOST IMPORTANTLY A FIVE-FOLD RISK OF STROKE,. ONE-IN-FOUR STROKE PATIENTS ARE ADMITTED IN AF AND ABSOLUTE RISK RANGES FROM LESS THAN 1% TO 20% PER YEAR, DEPENDING ON THE INDIVIDUAL CLINICAL RISK FACTORS. RECENT GUIDELINES STRONGLY RECOMMEND A PRACTICE SHIFT TOWARDS GREATER FOCUS ON IDENTIFICATION OF ‘TRULY LOW-RISK’ PATIENTS I. E. THOSE AGED 65 OR LESS WITH ‘LONE AF’ WHO DO NOT NEED ANY ANTITHROMBOTIC THERAPY, INSTEAD OF TRYING TO FOCUS ON IDENTIFYING ‘HIGH-RISK’ PATIENTS. DIAGNOSING AF BEFORE THE FIRST COMPLICATIONS OCCUR IS A RECOGNIZED PRIORITY FOR THE PREVENTION OF STROKES. IT IS THEREFORE RECOMMEND THAT, IN PATIENTS AGED 65 YEARS OR OVER, OPPORTUNISTIC SCREENING FOR AF BY PULSE PALPATION, FOLLOWED BY RECORDING OF AN ECG TO VERIFY DIAGNOSIS, SHOULD BE CONSIDERED FOR THE EARLY DETECTION OF AF. SEVERAL ORGANIZATIONS HAVE CREATED CAMPAIGNS TO ENCOURAGE ITS MEMBERS AS WELL AS THE GENERAL POPULATION TO TAKE ACTION AND TO FIGHT AGAINST AF AND AF-RELATED STROKE. THE HEALTHCARE SYSTEMS SHOULD COPE WITH THE GROWING HEALTH AND ECONOMIC BURDEN PRESENTED TO IT BY AF AND ITS COMPLICATIONS THROUGH INCREASING PROFESSIONAL AND PUBLIC EDUCATION. IN ADDITION, TECHNOLOGICAL ADVANCES IN NON-PHARMACOLOGICAL APPROACHES, PARTICULARLY IN CATHETER-BASED TECHNIQUES, HAVE RECENTLY OFFERED THE PROMISE OF A DEFINITIVE CURATIVE TREATMENT FOR AF.

 
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