Feature | April 10, 2014

New Atrial Fibrillation Guideline Covers Novel Anticoagulants, Ablation

More comprehensive risk calculator recommended

April 10, 2014 — The 2014 Guideline for the Management of Patients With Atrial Fibrillation includes recommendations for an increased use of radio frequency (RF) ablation in the treatment of non-valvular atrial fibrillation, the addition of three new anticoagulants to treatment options, a diminished role in the use of aspirin and a more comprehensive risk calculator.

Released by the American Heart Association (AHA), American College of Cardiology (ACC) and Heart Rhythm Society (HRS), in collaboration with the Society of Thoracic Surgery (STS), the document incorporates new and existing knowledge derived from published clinical trials, basic science and comprehensive review articles, along with evolving treatment strategies and new drugs. The guideline supersedes the “2006 ACC/AHA/ESC Guideline for the Management of Patients With Atrial Fibrillation” and two subsequent focused updates from 2011.

The document contains the most updated consensus of clinicians with broad expertise related to atrial fibrillation and its treatment, including adult cardiology, electrophysiology, cardiothoracic surgery and heart failure.

According to the writing committee's chair, Craig T. January, M.D., Ph.D., professor of medicine in the division of cardiovascular medicine at the University of Wisconsin-Madison, a fellow of the ACC, and a member of the AHA and HRS, the document contains four new significant recommendations. Among these are to use a more comprehensive thromboembolic risk calculator, the CHA2DS2-VASc calculator, to estimate a patient's risk of having a stroke. "Most previous guidelines used a simpler risk calculator," January said. "We recommend a more detailed risk calculator that provides more information."

Regarding treatment, the new guideline diminishes the role of aspirin. In the previous document, treatment protocols called for clinicians to prescribe aspirin to patients with atrial fibrillation who had a low stroke risk. "But data showing that aspirin decreases stroke risk is weak," said January. The new guideline also includes recommendations for the use of three new anticoagulants for non-valvular atrial fibrillation that have entered the marketplace within the last two years. Previously, the only recommended anticoagulant was coumadin (warfarin). Now, the guideline recommendations include using dabigatran, rivaroxaban and apixaban as well.

"Because what we say in the guideline can affect how a drug is used, we were careful to be even-handed and evidence-based in presenting new drugs," January said. "Our goal was to provide useful, non-biased information."

In addition, the guideline calls for an increased role of RF ablation in treating atrial fibrillation. "As experience with RF ablation grows, there has been an increased recognition that it can be used effectively as an atrial fibrillation treatment," January said.

The guideline is organized thematically with recommendations provided in each section. Some recommendations from earlier guidelines were eliminated or updated, as warranted by new evidence or a better understanding of earlier evidence. Each recommendation is assigned a level of evidence (estimate of certainty of treatment effect) as well as a size of the treatment effect (comparing benefit with risk). 

The guideline also includes a discussion of the basic science underlying atrial fibrillation, said January, who works broadly in the area of cellular mechanisms of cardiac arrhythmias, including mechanisms of drug effects and toxicity. 

"The goal is to have a document that is useful to the practicing physician and makes sense," January concluded. "The writing committee worked diligently to ensure that the data, tables and figures were clear and easy to use."

For more information: www.cardiosource.org, www.americanheart.org and www.hrsonline.org

Related Content

Biotronik Home Monitoring implanted EP device remote wireless monitoring system
News | May 24, 2017
May 23, 2017 – Results now published in the European Heart Journal show Biotronik Home Monitoring reduces th
Sponsored Content | Videos | Pacemakers| May 23, 2017
Vivek Reddy, M.D., director of cardiac arrhythmia services and professor of medicine, cardiology, Mount Sinai Hospita
Sponsored Content | Videos | Cardiac Resynchronization Therapy Devices (CRT)| May 23, 2017
This video, provided by ERB, demonstrates the function and implantation of the WiSE CRT (Wireless Stimulation Endocar
Sponsored Content | Videos | Atrial Fibrillation| May 17, 2017
Hugh Calkins, M.D., FACC, FAHA, FHRS, director of cardiac arrhythmia services and professor of medicine at Johns Hopk
Sponsored Content | Videos | EP Lab| May 17, 2017
This video, provided by Spectranetics, demonstrates how to deploy the Bridge Occlusion Balloon used to seal accidenta
Biosense Webster multi-electrode RF ablation balloon

Biosense Webster's multi-electrode RF ablation balloon with irrigation. The system allows operators to change the energy levels of each electrode to avoid damaging sensitive underlying critical structures like the esophagus or phrenic nerve.

Feature | Ablation Systems| May 17, 2017 | Dave Fornell
May 17, 2017 – Clinical trial results from a first-in-human study evaluating the acute feasibility of an investigatio
Spectranetics Bridge Occlusion Balloon in the SVC

An illustration of how the Bridge balloon can seal the SVC after an accidental tear from lead extration.

Feature | EP Lab| May 17, 2017 | Dave Fornell
May 17, 2017 — A new intravenous occlusion balloon designed to seal any accidental tears in the superior vena cava (S
Medtronic Reveal Linq implantable cardiac monitor

The Medtronic Reveal Linq implantable cardiac monitor is the smallest implantable monitor on the market. It is used as a long-term Holter monitor for 24-hour a day, 365-day a year patient monitoring. The device uses wireless connectivity to download the patient data with a patient bedside base unit to send the information over the internet so it is accessible by physicians.

Feature | Atrial Fibrillation| May 16, 2017
May 16, 2017 - The study using small, subcutaneous implantable cardiac monitors for long-term, 24-hour a day monitori
NewPace string subcutaneous ICD system

The NewPace string subcutaneous ICD system.

News | May 16, 2017
May 16, 2017 – A new study examines the effectiveness of the implantable subcutaneous string defibrillator (ISSDTM),
Overlay Init