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Focused update features changes in management of AF
Wann LS. Heart Rhythm. 2011;8:157-176.
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The American College of Cardiology, American Heart Association and the European Society of Cardiology have announced changes to the 2006 guidelines for the management of patients with atrial fibrillation, one of which stating that strictly controlling a patient’s heart rate is not beneficial over a more lenient approach.
According to the 2011 Focused Update, based on the findings of several trials, including RACE II and AFFIRM, strict treatment for controlling a patient’s heart rate (<80 beats per minute at rest, <110 during a 6-minute walk) was determined to not be beneficial over a more lenient approach of achieving a resting heart rate of less than 110 beats per minute in patients with persistent AF with stable functioning ventricles.
“The evidence showed rigid control did not seem to benefit patients,” L. Samuel Wann, MD, chair of the focused update writing group and director of cardiology at the Wisconsin Heart Hospital, Milwaukee, said in a press release. “We don’t need to be as compulsive about absolute numbers, particularly doing exercise tests and giving multiple drugs based solely on heart rate.”
Drug-specific updates to the guidelines included: classifying the combination of aspirin and clopidogrel (Plavix, Sanofi-Aventis) as “might be considered” in the prevention of stroke or other types of blood clots in AF patients who are poor candidates for warfarin; and recommending that dronedarone (Multaq, Sanofi-Aventis) not be taken by patients with NYHA Class IV HF or those who have had an episode of decompensated HF in the past 4 weeks, particularly if they have depressed ventricular function.
Also highlighted in the focused update were new or revised recommendations that support catheter ablation as a treatment for maintaining normal heart rhythm. According to the update, catheter ablation “is useful in maintaining sinus rhythm” for patients who have symptomatic paroxysmal AF, who have had no success with drug treatment, who do not have severe lung disease, and who have a normal or mildly dilated left atrium and normal or mildly reduced function of the left ventricle.
Disclosure: Dr. Wann reports no relevant financial disclosures.
In medicine, new data is frequently generated through clinical trials and other opportunities that help us better understand our patients and how they will respond to therapy. Because of these changes, it remains critical for the Heart Rhythm Society and other societies to develop and update guidelines for the practicing clinician. Due to the emergence of new AF clinical trial evidence in recent years, it was time to collaborate with the American Heart Association and the American College of Cardiology to update the 2006 Guidelines for the Management of Patients with Atrial Fibrillation. The information provided in the updated guidelines is timely, relevant and based on the latest evidence from important clinical trials. Sharing this information with physicians will ultimately lead to better safety and effectiveness of treatment for our patients.
– Douglas L. Packer, MD
President, Heart
Rhythm Society
Disclosure: Dr. Packer reports having been a speaker for Sanofi Aventis.
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