2) This program is intended for #healthcare providers & is supported by an independent educational grant from Sanofi. Statement of accreditation & faculty disclosures at https://t.co/gvXca4G9Xm.#FOAMed #CardioTwitter @MedTweetorials
— cardio-met (@cardiomet_CE) October 18, 2023
3b) and @aayshacader @kfarooqi @pedschwartzmann @ToddVillinesMD @LucySafi @alinsairMD @MaryjaneFarrMD @hvanspall#FOAMed #CardioTwitter @MedTweetorials @AtrialFib_US @KnowYourPulse @stopafib @StopTheClot pic.twitter.com/Kcf96lyMNV
— cardio-met (@cardiomet_CE) October 18, 2023
5) There are also many pts w/undiagnosed #AF who are first detected only after a #stroke, development of #LV dysfunction, or incidentally. AF is assoc'd w/ substantial #mortality & #morbidity, ➡️significant burden to patients and health care services
— cardio-met (@cardiomet_CE) October 18, 2023
🔓 https://t.co/2ctD4LyGXI pic.twitter.com/NAcv8SNWrC
7) The 2⃣ questions are: #rhythm control or #rate control? … And when to decide on one strategy or the other pic.twitter.com/9KRFuIoqtI
— cardio-met (@cardiomet_CE) October 18, 2023
8b) It should be noted that most of the patients in the early rhythm control branch were treated with #antiarrhythmic drugs #AADs and only 20% underwent #ablation, so the results cannot be attributed to one intervention over the other in this group. pic.twitter.com/Bd137c2sb7
— cardio-met (@cardiomet_CE) October 18, 2023
10) So . . . #Rhythm control: better early or late? ⌛️
— cardio-met (@cardiomet_CE) October 18, 2023
And it's equally important to recognize the benefit of rhythm-control strategies for a wide range of patients in understanding the importance of early adoption of this approach.
12) Rhythm control in #AFib is better with:
— cardio-met (@cardiomet_CE) October 18, 2023
a. medical treatment
b. ablation
c. the important thing is early control
14a) What evidence does real world data give us? In 2021, a retrospective analysis of 22,636 pts with recent-dx #AF extracted from the database of the National Health System of 🇰🇷 tx'd by rhythm control (#AADs or catheter ablation) or by rate control 2011-2015.
— cardio-met (@cardiomet_CE) October 18, 2023
14c) The start of rhythm control within 6 months of the dx of #AF also ⬇️risk of hospitalization for #heartfailure #HHF:
— cardio-met (@cardiomet_CE) October 18, 2023
🏥 6 months HR: 0.84; 95% CI, 0.74–0.95
🏥 1 year HR: 0.96; 0.82–1.13
🏥 5 years HR: 2.88; 1.34–6.17.
🔓 https://t.co/z32SfVcLaz pic.twitter.com/2l0EISUCMK
16a) In the same longitudinal observational cohort study from 🇰🇷 of 22,635 adults w/#AF & #CV comorbidities, pts w/early (within 1yr of dx) rhythm control of AF were compared to pts who had only rate control.
— cardio-met (@cardiomet_CE) October 18, 2023
🔓 https://t.co/0Q6G3a5qus
16c) There was NO difference in the risk of the primary composite outcome in pts with late tx–initiated after one year since diagnosis–for #atrial #fibrillation.
— cardio-met (@cardiomet_CE) October 18, 2023
➡️ In conclusion, the window of opportunity is less than 1 year. pic.twitter.com/1dFp1LVuRE
18) Early rhythm control is especially important in pts w/comorbidities or #HF. A subanalysis of the randomized #EAST_AFNET4 trial of pts w/ HF ➡️early rhythm control therapy improved the composite outcome of ☠️or #HHF.
— cardio-met (@cardiomet_CE) October 18, 2023
🔓 https://t.co/WQk5dnJvkZ pic.twitter.com/amUZqrCGgh
20) So how do we accomplish early rhythm control?
— cardio-met (@cardiomet_CE) October 18, 2023
1⃣ Drugs (#AAD)
2⃣ ablation pic.twitter.com/bNorb2Vxnt
21b) In general, AADs approximately double the likelihood of maintaining sinus rhythm compared with no rhythm-control therapy.https://t.co/mcXSf7lFPu pic.twitter.com/CZgSJvmkJf
— cardio-met (@cardiomet_CE) October 18, 2023
23) In #ATHENA, #dronedarone ⬇️ risk vs placebo of a primary outcome or hospitalization due to unexpected #CV events or death from any cause.
— cardio-met (@cardiomet_CE) October 18, 2023
Also a significant ⬇️ in secondary outcomes with dronedarone, including #cardiovascular death & #stroke as single outcomes pic.twitter.com/3bb6o3SIHK
25) Option 2⃣: Results from #ATTEST ➡️ early ablation as part of standard care was superior to #AAD therapy alone in delaying progression recurrent paroxysmal ➡️persistent AF, apparent at 1yr of f/u & maintained over 3 yrshttps://t.co/LUZyICHUX6 pic.twitter.com/i6nivtYMw7
— cardio-met (@cardiomet_CE) October 18, 2023
27a) In the future 🔮, we may see
— cardio-met (@cardiomet_CE) October 18, 2023
🫀 small conductance calcium-activated potassium (#SK)-channel inhibitors
🔓 https://t.co/GB1sXZGrKO
🫀 #TWIK-related acid-sensitive potassium channel (TASK-1) inhibitors
(cont)
28) Another point of view is the data captured by wearable sensors such as increasingly ubiquitous #smartwatches can facilitate highly scalable AF detection. Identification of early but often asx cases of AF ➡️opportunity to tackle the disease.https://t.co/QlklF5uLfO pic.twitter.com/fALRNN8RiW
— cardio-met (@cardiomet_CE) October 18, 2023
29b) #AADs and ablation are options to be assessed in shared decision-making with the patient. @MohitTuragam et al (🔓 https://t.co/YAxV7eHDUa) offer potential structure for that discussion. Catheter ablation is an #invasive procedure with the potential for #complications.
— cardio-met (@cardiomet_CE) October 18, 2023
29d) #AEs from long-term #AADs are mostly related to persistent AF and structural heart disease, so even with suboptimal efficacy, #AADs are a reasonable option as first-line therapy, with a plan to consider catheter ablation if they fail.
— cardio-met (@cardiomet_CE) October 18, 2023
See 🔓 https://t.co/IIfpmO2xjG pic.twitter.com/tNKwo1dW8J
30a) What is the incidence of major complications (#stroke or #TIA, cardiac perforation, atrial-esophageal fistula, phrenic nerve injury, AV fistula, death) for catheter #ablation for atrial fibrillation?
— cardio-met (@cardiomet_CE) October 18, 2023
a. 0%
b. 0.1% to 1%
c. 1% to 5%
d. Greater than 10%
31) And so … CONGRATULATIONS! You just earned 0.5hr 🆓 CE/#CME credit. Grab your certificate now at https://t.co/dSEokiI8mH and then FOLLOW US for more expert-led #MedEd delivered wholly on X!@cardiomet_ce and @ValleAlfonso thank you for joining!
— cardio-met (@cardiomet_CE) October 18, 2023