Atrial Fibrillation
AF progresses...
even without AF.
The role of
'Second Factor'.
AF progresses even without AF.
The role of 'Second Factor'.
Characters of the Second Factors
Atrial Fibrosis
Atrial conduction delay and atrial voltage reduction
Atria Remodelling as Consequences of Sustained Obesity (1/2)

20 sheeps

Induced obesity
over 36wks
Maintained obesity
over another 36wks.
Mean weight 110kgs.

normal weight.
Mean weight 60 kgs.
Atria Remodelling as Consequences of Sustained Obesity (2/2)
More fibrosis in obesed sheeps than that of control (8% vs 5%).
Obesity and
the substrate for AF.
Risk Factors and Mechanism of AF
Meta-analysis of 9.6 millions participants showed the association of AF and poor outcomes.
AF & Stroke: A risk factor or risk marker?
  • Stroke may occur even without AF being present.
    In a substudy from ASSERT, AF was detected before stroke or SE only in 35%. (Circulation 2014.)
  • AF patients died of non-stroke related death much more than stroke related death.
    In GARFIELD-AF, the most frequent 2-yr major outcomes of patients with new AF was death; less than 10% were stroke related. (Eur Heart J 2016.)
Worse outcomes in permanent and persistent than in paroxysmal AF.
Data from ENGAGE AF-TIMI 48 trial. 21 105 patients, 2.8 years f/u. Circulation: Arrhythmia and Electrophysiology. 2017
Treating HTN and HF to prevent AF.

from LIFE study (JACC 2005).

from EMPHASIS-HF (JACC 2012).
Be Fit to Fight off AF.
 RISK  FACTORS  Management and Goals
 integrated  CARE  for Atrial Fibrillation
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