Cardiovasculaire Geneeskunde.nl

IVG 2010 Presentatie 3

Slides (presentatie) - Dec. 12, 2010

Atriumfibrilleren – in welke richting beweegt het onderzoek zich ? Isabelle C Van Gelder University Medical Center Groningen The Netherlands

AF – future research

Classification of AF

Clinical events affected by atrial fibrillation

Associated diseases

Systolic blood pressure and new AF

Rhythm control

Amiodarone the best: SAFE-T

Prediction of successful rhythm control

PA-tdi

New onset AF associated with severity of structural remodeling

Diagnostics to evaluate atrial substrate for AF

AFFIRM and RACE

Atrial remodeling starts far before first AF

ACE-I and ARBs for prevention of AF

Primary prevention in hypertensives and LVH

Primary prevention in hypertensives and LVH

Primary prevention with ACE-I early after AMI with LV-dysfunction

Future goal: primary prevention in patients at risk

Future goal: upstream therapy for secondary prevention

GISSI AF: secondary prevention in AF and risk factors with valsartan

Time to first recurrence of AF

GISSI AF: secondary prevention with valsartan

ACE-I/ ARB + amiodarone is superior

RACE 3 Routine versus aggressive upstream rhythm control for prevention of early atrial fibrillation in heart failure

Hypothesis RACE 3

Endpoints

Inclusion criteria

Inclusion criteria

Definitions

Inclusion

Reduction of CV morbidity and mortality

Cardiovascular events in AF patients (RACE)

MACCE and hospitalization in 5333 AF patients Euro Heart AF Survey

Do not shoot the messenger AF Get the message that AF represents vascular disease

Prevention CV morbidity and mortality

New treatment goals in AF and unmet need

New treatment goals in AF and unmet need

Eurides, Adonis: Dronedarone for rhythm control

Dionysos: Dronedarone vs Amiodarone

Erato: Dronedarone for rate control

ATHENA – endpoints

ATHENA: Dronedarone for prevention CV morbidity and mortality

ATHENA – primary endpoint

ATHENA – death from cardiovascular cause – 29%

ATHENA – 1st hospitalization due to CV events – 26%

Dronedarone reduces CV hospitalizations: – 26%

ATHENA - risk of stroke – 34%

Dronedarone – safety: adverse events

Potential ways in which dronedarone could influence morbidity and mortality

Upstream therapy for prevention CV morbidity and mortality

Conclusions

Thank you for your attention

Conclusions dronedarone

Dronedarone – multiple benefits

Upstream therapy – applying drugs that ameliorate the substrate of AF

Why upstream therapy ?

AF – natural time course

Endpoints/ outcome parameters in AF trials

Prevalence of atrial fibrillation

Primary prevention of AF

Identify patients at risk for AF

Identify patients at risk for AF

Diastolic heart failure and risk on AF

Identify patients at risk for AF

Non ion channel AADs may inhibit pathways that promote atrial remodeling

Vraag 2

Secondary prevention with ACE-I/ARB and amiodarone

GISSI AF: secondary prevention in AF and risk factors with valsartan

Time to first recurrence of AF

GISSI AF: secondary prevention with valsartan

Vraag 3

Statins for the prevention of AF

Statins and AF: a meta-analysis

GISSI HF: primary prevention in HF patients with rosuvastatin 10 mg

GISSI HF

GISSI HF

GISSI HF: role of statins

GISSI HF: role of statins

Upstream therapy: future

RACE 3 Routine versus aggressive upstream rhythm control for prevention of early atrial fibrillation in heart failure

Conclusions

Conclusions

Interdependence of AF mechanisms

HATCH score to predict AF progression

AF is a progressive disease

‘My take home message’

MACCE and hospitalization in 5333 AF patients Euro Heart AF Survey

Indication for LA Catheter Ablation

Ablation when structural heart disease is present

Modulating factors for AF

Risk of AF in 10 years

HATCH score and AF progression 1 Year AF progression in 1219 paroxysmal AF patients, EuroHeartSurvey on AF

Primary prevention of AF

Diagnostics to evaluate atrial substrate for AF

Primary prevention of AF

Identify patients at risk for AF

Identify patients at risk for AF

Possible new risk factors

Nieuwlaat R et al, Eur Heart J 2008

Efficacy of Amiodarone and Dronedarone in preventing recurrence of AF

AF – the epidemic

Rhythm control

Was Antiarrhythmic Effect Important? Permanent AF Patients

Cardiovascular events in permanent AF (RACEII)

Rhythm control

Prediction of successful AF ablation

Prediction of successful AF ablation

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