Klinikai vizsg

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Klinikai vizsgálatok PF-bankülönös tekintettel a
néma PF-ra

• Zámolyi Károly
• Szent Ferenc Kórház, Budapest

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Natural time course of AF
Elso kivizsgálás, ok keresés
alapbetegség lone?
AF atrial fibrillation
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Diagnosis and initial management of AF
aClass of recommendation. bLevel of evidence. AF
atrial fibrillation ECG electrocardiogram
EHRA European Heart Rhythm Association.
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EHRA score of AF- related symptoms
AF atrial fibrillation EHRA European Heart
Rhythm Association
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Diagnosis and initial management of AF
aClass of recommendation. bLevel of evidence. AF
atrial fibrillation ECG electrocardiogram.
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Diagnosis and initial management of AF
aClass of recommendation. bLevel of evidence. AF
atrial fibrillation ECG electrocardiogram.
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AF is a risk factor for silent stroke

• The Framingham Offspring Study
• 2,040 asymptomatic subjects (free of clinical
  stroke) underwent MRI
• At least 1 silent cerebral infarct was present in
  10.7 of participants
• Prevalent silent cerebral infarct was associated
  with AF

ODS ratio (95 CI) for silent cerebral infarct
was 2.3
Das RR, et al. Stroke. 2008392929-35.
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Cryptogenic Stroke
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AHA/ASA Guideline - 2014 Guidelines for the
Prevention of Stroke in Patients With Stroke and
Transient Ischemic Attack
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Feedback Loop for Care Team
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Evaluation for Cryptogenic Stroke
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How AF Is Detected in Cryptogenic Stroke Patients
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Monitoring Continuum
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Prevalence of Unknown Atrial Fibrillation in
Patients With Risk Factors Europace. 201315(5)65
7-662. 
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ASSERT StudyThe Asymptomatic Atrial Fibrillation
and Stroke Evaluation in Pacemaker Patients and
the Atrial Fibrillation Reduction Atrial Pacing
Trial

• 2580 pacemakeres és ICD-s beteg gt 65 év,
  hypertonia PF nélkül
• Szubklinikus PF (SCAF gt 6 perc) vizsgálata
• 51 betegnek stroke vagy szisztémás embolizáció
  51 szubklinikus PF
• 35-nak volt a stroke elott detektálható SCAF
  (8 lt30 nap)
• 8 beteg (16) a SCAF csak a stroke után
  detektálódott, a folyamatos
• monitorozás ellenére (medián ido 228 nap)
• Konklúzió Kevés betegnél jelentkezik SCAF az
  esemény elott egy
• hónapon belül

Brambatti M et al Circulation 20141292094
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SURPRISE TRIAL
Stroke Prior to Diagnosis of Atrial Fibrillation
Using Long-Term Observation with Implantable
Cardiac Monitoring Apparatus Reveal
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Atrial Fibrillation Duration in ICM Arm at 12
Months (N 29)
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DISCERN AFProspective Multicenter Study
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Sic itur ad astra
Köszönöm a figyelmet