News from the 2010 guidelines for the treatment of patients with atrial fibrillation
Authors:
R. Čihák
Published in the journal:
Kardiol Rev Int Med 2010, 12(4): 187-191
Category:
Angiological Symposium
Summary
In summer 2010, the European Society of Cardiology published its new guidelines for the management of patients with atrial fibrillation. The incidence of atrial fibrillation increases, the prevalence is estimated at 1–2%. The treatment includes prevention of atrial remodelling with upstream therapy, prevention of thromboembolic events and heart rate control and rhythm control. Great emphasis is on treatment safety. Detailed risk stratifications of thromboembolic complications have been introduced, the CHA2DS2-VASc score, and risks of bleeding, the HAS-BLED score. Anticoagulation treatment is indicated more often rather than earlier, and recommended are vitamin K antagonists, with, following its approval for use in AF, administration of dabigatran as an alternative. Heart rate control should aim at achieving resting heart rate of less than 110 bpm with more intensive control when symptoms persist or the function deteriorates. To rhythm control, dronedarone, propaphenone, flecainide, sotalol and amiodarone are recommended. The choice of an antiarrhythmic depends on the presence of structural heart disease. Catheter ablation, or alternatively surgery, is indicated when pharmacological treatment had been ineffective.
Keywords:
atrial fibrillation – treatment guidelines – upstream therapy – thromboembolism prevention – rate control – rhythm control
Zdroje
1. Camm AJ, Kirchhof P, Lipp GY et al. European Heart Rhythm Association; European Association for Cardio--Thoracic Surgery. Guidelines for the management of atrial fibrillation: the Task Force for thr Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010; 31: 2369–2429.
2. Fuster V, Rydén LE, Cannom DS et al. American College of Cardiology; American Heart Association Task Force; European Society of Cardiology Committee for Practice Guidelines; European Heart Rhythm Association; Heart Rhythm Society. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 guidelines for the management of patients with atrial fibrillation) developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Europace 2006; 8: 651–645.
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8. Hohnloser SH, Crijns HJ, van Eickels M et al. ATHENA Investigators. Effect of dronedarone on cardiovascular events in atrial fibrillation. N Engl J Med 2009; 360: 668–678.
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Štítky
Paediatric cardiology Internal medicine Cardiac surgery CardiologyČlánok vyšiel v časopise
Cardiology Review
2010 Číslo 4
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