{"id":9048,"date":"2025-10-27T21:17:34","date_gmt":"2025-10-27T18:17:34","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=9048"},"modified":"2025-10-27T21:17:34","modified_gmt":"2025-10-27T18:17:34","slug":"draft-jordanian-af-management-framework-2025-adapted-from-esc-and-aha-guidelines-using-the-pipoh-model","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/draft-jordanian-af-management-framework-2025-adapted-from-esc-and-aha-guidelines-using-the-pipoh-model\/","title":{"rendered":"Draft \u2013 Jordanian AF Management Framework 2025 (Adapted from ESC and AHA Guidelines using the PIPOH Model)"},"content":{"rendered":"
Draft \u2013 Jordanian AF Management Framework 2025<\/div>\n
(Adapted from ESC and AHA Guidelines using the PIPOH Model)<\/div>\n
<\/div>\n
Speaker: Dr. Mohammad Hajjiri<\/div>\n
EP Task Force \u2013 Jordanian Cardiac Society (JCS)<\/div>\n
Interventional Electrophysiology \u2013 Abdali Hospital<\/div>\n
<\/div>\n
Keynotes :<\/div>\n
\u20071.\u2060 \u2060Purpose and Scope<\/div>\n
\u2022 Standardize AF management across public, private, and military sectors in Jordan.<\/span><\/div>\n
\u2022 Reduce stroke risk, improve outcomes, and ensure proper DOAC utilization.<\/span><\/div>\n
<\/div>\n
\u20072.\u2060 \u2060PIPOH Framework<\/div>\n
Used by WHO, and aligned with AHA principles, the PIPOH framework helps adapt global cardiovascular guidelines to local healthcare systems by defining the following elements:<\/div>\n
\u2022 P \u2013 Population: Patients with atrial fibrillation (AF).<\/span><\/div>\n
\u2022 I \u2013 Interventions: Diagnosis, risk scoring, anticoagulation, rate\/rhythm control, and ablation.<\/span><\/div>\n
\u2022 P \u2013 Professionals: Internists, family physicians, cardiologists, electrophysiologists.<\/span><\/div>\n
\u2022 O \u2013 Outcomes: Improved rhythm control, reduced stroke burden, and standardized national practice.<\/span><\/div>\n
\u2022 H \u2013 Healthcare Setting: Primary, secondary, and tertiary care levels.<\/span><\/div>\n
<\/div>\n
\u20073.\u2060 \u2060Diagnosis<\/div>\n
\u2022 ECG \u2265 30 seconds confirms atrial fibrillation (AF).<\/span><\/div>\n
This duration ensures diagnostic accuracy and distinguishes true, clinically significant AF from brief atrial runs that do not warrant anticoagulation or formal labeling as AF.<\/div>\n
\u2022 If < 30 seconds: classify as subclinical AF, which requires further evaluation but is not diagnostic of AF.<\/span><\/div>\n
\u2022 Extended ECG monitoring (Holter 24\u201348 h, patch up to 14 days, and Implantable Loop Recorder (ILR) for several months up to 3 years) is recommended in patients with suspected silent or paroxysmal AF, or following a cryptogenic stroke.<\/span><\/div>\n
<\/div>\n
\u20074.\u2060 \u2060Stroke Risk Stratification<\/div>\n
\u2022 Use CHA\u2082DS\u2082-VA (sex removed) as per ESC 2024 update.<\/span><\/div>\n
\u2022 Reassess stroke and bleeding risks annually (Class I).<\/span><\/div>\n
<\/div>\n
\u2022 Consider AF burden, comorbidities, and atrial imaging (size or fibrosis) when assessing stroke risk.<\/span><\/div>\n
These factors help refine individual risk beyond the CHA\u2082DS\u2082-VA(S)c score.<\/div>\n
<\/div>\n
\u20075.\u2060 \u2060Bleeding Risk<\/div>\n
\u2022 HAS-BLED has limited predictive value.<\/span><\/div>\n
\u2022 Focus on modifiable risk factors instead of score alone.<\/span><\/div>\n
<\/div>\n
\u20076.\u2060 \u2060Anticoagulation<\/div>\n
\u2022 DOACs are first-line (Class I).<\/span><\/div>\n
\u2022 Warfarin only for mechanical valves or severe mitral stenosis.<\/span><\/div>\n
\u2022 Continue indefinitely unless contraindicated or LAA occlusion done.<\/span><\/div>\n
<\/div>\n
Available in Jordan:<\/div>\n
\u2022 \u2705 Apixaban, Dabigatran, Rivaroxaban<\/span><\/div>\n
\u2022 \u274c Edoxaban (not available)<\/span><\/div>\n
<\/div>\n
Apixaban dosing:<\/div>\n
\u2022 Standard: 5 mg BID<\/span><\/div>\n
\u2022 Reduce to 2.5 mg BID if 2 of 3:<\/span><\/div>\n
\u2022 Age \u2265 80 years<\/span><\/div>\n
\u2022 Weight \u2264 60 kg<\/span><\/div>\n
\u2022 Serum creatinine \u2265 1.5 mg\/dL<\/span><\/div>\n
<\/div>\n
\u20077.\u2060 \u2060Rate Control<\/div>\n
\u2022 Acute:<\/span><\/div>\n
\u2022 Beta-blockers or Diltiazem\/Verapamil (avoid if EF < 40%).<\/span><\/div>\n
\u2022 Amiodarone or Digoxin for severe LV dysfunction.<\/span><\/div>\n
\u2022 Chronic:<\/span><\/div>\n
\u2022 Use Beta-blockers mainly (Bisoprolol, Metoprolol).<\/span><\/div>\n
\u2022 Diltiazem: limited by local shortage.<\/span><\/div>\n
\u2022 Target HR:<\/span><\/div>\n
\u2022 <110 bpm (lenient) for most.<\/span><\/div>\n
\u2022 <80 bpm (strict) if symptomatic or young.<\/span><\/div>\n
<\/div>\n
\u20078.\u2060 \u2060Rhythm Control<\/div>\n
\u2022 Amiodarone remains dominant in Jordan.<\/span><\/div>\n
\u2022 Flecainide increasing use in structurally normal hearts (with AV-nodal blocker).<\/span><\/div>\n
\u2022 Unavailable: Vernakalant, Dofetilide, Sotalol (limited), Ibutilide.<\/span><\/div>\n
\u2022 Electrical cardioversion: Class I for unstable or symptomatic cases.<\/span><\/div>\n
\u2022 \u201cPill-in-the-pocket\u201d (Flecainide\/Propafenone): acceptable if previously tested safe.<\/span><\/div>\n
<\/div>\n
\u20079.\u2060 \u2060Catheter Ablation<\/div>\n
\u2022 Class I: Symptomatic AF refractory\/intolerant to antiarrhythmic drugs (AADs).<\/span><\/div>\n
\u2022 Class I: In patients with HFrEF (proven benefit in trials).<\/span><\/div>\n
\u2022 Perform only in specialized centers.<\/span><\/div>\n
\u2022 3D mapping and image-guided ablation now standard practice.<\/span><\/div>\n
<\/div>\n
10.\u2060 \u2060Pulsed-Field Ablation (PFA)<\/div>\n
\u2022 FDA-approved (Dec 2023) \u2013 Medtronic PulseSelect system.<\/span><\/div>\n
\u2022 Non-thermal, tissue-selective, and reduces collateral injury.<\/span><\/div>\n
\u2022 Safety: 0.7% event rate \u2014 lowest among AF ablation trials.<\/span><\/div>\n
\u2022 Efficacy: ~70% freedom from recurrent AF\/AT at follow-up.<\/span><\/div>\n
<\/div>\n
11.\u2060 \u2060Key Jordan-Specific Adaptations<\/div>\n
1. Anticoagulation: DOACs first-line; Apixaban widely used; Edoxaban unavailable.<\/span><\/div>\n
2. Rate control: Beta-blockers are mainstay; Diltiazem often in shortage.<\/span><\/div>\n
3. Rhythm control: Amiodarone still common; Flecainide use expanding.<\/span><\/div>\n
4. Ablation: Rapid growth, especially for HFrEF and symptomatic patients.<\/span><\/div>\n","protected":false},"excerpt":{"rendered":"

Draft \u2013 Jordanian AF Management Framework 2025 (Adapted from ESC and AHA Guidelines using the PIPOH Model) Speaker: Dr. Mohammad Hajjiri EP Task Force \u2013 Jordanian Cardiac Society (JCS) Interventional Electrophysiology \u2013 Abdali Hospital Keynotes : \u20071.\u2060 \u2060Purpose and Scope \u2022 Standardize AF management across public, private, and military sectors in Jordan. \u2022 Reduce stroke […]<\/p>\n","protected":false},"author":145,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-9048","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9048","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/145"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=9048"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9048\/revisions"}],"predecessor-version":[{"id":9049,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9048\/revisions\/9049"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=9048"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=9048"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=9048"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}