HRS 2009 Abstract: Long-term Outcome of Remote Catheter Ablation Using a Magnetic Irrigated-tip Catheter.Before consideration of AF catheter ablation, assessment of the procedural risks and outcomes relevant to the individual patient is recommended. (Level of Evidence: C) Class IIa 1.ESC Guidelines For The Management Of Atrial Fibrillation European.OpenUrl CrossRef PubMed 50. Frost L., Vestergaard P., Mosekilde L. ( 2004 ) Hyperthyroidism and risk of atrial fibrillation or flutter: a population-based study.
OpenUrl PubMed 185. Feld G.K., Fleck R.P., Fujimura O., et al. ( 1994 ) Control of rapid ventricular response by radiofrequency catheter modification of the atrioventricular node in patients with medically refractory atrial fibrillation.For patients with nonvalvular AF and moderate-to-severe CKD with CHA 2 DS 2 -VASc scores of 2 or greater, treatment with reduced doses of direct thrombin or factor Xa inhibitors may be considered (e.g., dabigatran, rivaroxaban, or apixaban), but safety and efficacy have not been established. (Level of Evidence: C) 3.Anticoagulation is indicated in patients with hypertrophic cardiomyopathy (HCM) with AF independent of the CHA 2 DS 2 -VASc score (169,170). (Level of Evidence: B) Class IIa 1.For certain conditions for which inadequate data are available, recommendations are based on expert consensus and clinical experience and are ranked as LOE C.This can significantly increase mortality and morbidity, which can be prevented by early and adequate treatment of the AF.OpenUrl CrossRef PubMed 86. Connolly S.J., Eikelboom J., Joyner C., et al. ( 2011 ) Apixaban in patients with atrial fibrillation.Members may not draft or vote on any recommendations pertaining to their RWI.The energy emitting probe ( electrode ) is placed into the heart through a catheter inserted into veins in the groin or neck.
Management of Atrial Fibrillation: 2014 Guidelines - NEJM
OpenUrl CrossRef PubMed 180. Tamariz L.J., Bass E.B. ( 2004 ) Pharmacological rate control of atrial fibrillation.OpenUrl CrossRef PubMed 57. Benjamin E.J., Rice K.M., Arking D.E., et al. ( 2009 ) Variants in ZFHX3 are associated with atrial fibrillation in individuals of European ancestry.
Radiofrequency ablation (RFA) uses radiofrequency energy to destroy abnormal electrical pathways in heart tissue.Intravenous beta blockers are recommended to slow a rapid ventricular response to AF in patients with ACS who do not display HF, hemodynamic instability, or bronchospasm. (Level of Evidence: C) 3.Direct-current cardioversion should be attempted in patients with pulmonary disease who become hemodynamically unstable as a consequence of new-onset AF. (Level of Evidence: C) 6.5 Wolff-Parkinson-White and Pre-Excitation Syndromes Class I 1.
The successful introduction of new anticoagulants is encouraging, and further investigations will better inform clinical practices for optimizing beneficial applications and minimizing the risks of these agents, particularly in the elderly, in the presence of comorbidities and in the periprocedural period.
Multaq® Recommended in New ESC Guidelines for ManagementThe mainstay of maintaining sinus rhythm is the use of antiarrhythmic agents.The primary factors determining AF treatment are duration and evidence of circulatory instability.OpenUrl CrossRef PubMed 51. Mitchell G.F., Vasan R.S., Keyes M.J., et al. ( 2007 ) Pulse pressure and risk of new-onset atrial fibrillation.Anticoagulation may be interrupted at the time of the procedure to reduce the risk of bleeding at the site of peripheral arterial puncture. (Level of Evidence: C) 4.
Managing Anticoagulation for Atrial Fibrillation 2015Decisions on bridging therapy should balance the risks of stroke and bleeding. (Level of Evidence: C) 10.Implanted loop recorders, pacemakers, and defibrillators offer the possibility of reporting frequency, rate, and duration of abnormal atrial rhythms, including AF (31,32).
To compensate for the increased risk of stroke, anticoagulants may be required.If anticoagulation is required urgently (e.g. for cardioversion), heparin or similar drugs achieve the required level of protection much quicker than warfarin, which will take several days to reach adequate levels.
In patients with AF where rate control drugs are ineffective and it is not possible to restore sinus rhythm using cardioversion, non-pharmacological alternatives are available.OpenUrl CrossRef PubMed 113. You J.J., Singer D.E., Howard P.A., et al. ( 2012 ) Antithrombotic therapy for atrial fibrillation: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines.
OpenUrl CrossRef PubMed 127. Letelier L.M., Udol K., Ena J., et al. ( 2003 ) Effectiveness of amiodarone for conversion of atrial fibrillation to sinus rhythm: a meta-analysis.
The agents work by prolonging the Effective Refractory Period (ERP) either by blocking sodium ions (Class I drugs) or by blocking potassium ions (Class III drugs) or a mixture of both.AV node ablation should not be performed without a pharmacological trial to achieve ventricular rate control. (Level of Evidence: C) 2.OpenUrl CrossRef PubMed 16. Camm A.J., Lip G.Y., De Caterina R., et al. ( 2012 ) 2012 Focused update of the ESC guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation.Additionally, the writing committee reviewed documents related to AF previously published by the ACC and AHA.Gudbjartsson D.F., Arnar D.O., Helgadottir A., et al. ( 2007 ) Variants conferring risk of atrial fibrillation on chromosome 4q25.