A new guideline for atrial fibrillation (AF) was released on Friday by the American Heart Association, the American College of Cardiology, and the Heart Rhythm Society. Amid other functions, the 2014 Guideline for the Management of Individuals With Atrial Fibrillation incorporates important new details about the new oral anticoagulants and catheter ablation for the therapy of AF signs.
Perhaps the largest change since the earlier 2006 guideline has been the introduction of new oral anticoagulants, which can be utilized in some sufferers as an alternative of warfarin for stroke prevention. The new guideline includes recommendations for the use of dabigatran (Pradaxa, Boehringer Ingelheim), rivaroxaban (Xarelto, Johnson and Johnson), and apixaban (Eliquis, Pfizer and BristolMyers Squibb). Warfarin continues to be indicated for the therapy of AF in patients who have mechanical heart valves. The new agents are strongly recommended for use in individuals with nonvalvular AF who are unable to preserve a therapeutic INR level with warfarin.
Catheter ablation also will get a powerful recommendation when a rhythm control strategy is wanted in sufferers with symptomatic AF refractory to at least one antiarrhythmic drug. ”As knowledge with RF ablation grows, there has been an enhanced recognition that it can be utilised efficiently as an atrial fibrillation remedy,” explained Craig T. January, the writing committee’s chair, in a press release.
January also highlighted as substantial the guideline’s recommendation to use a more thorough thromboembolic danger calculator, the CHA2DS2-VASc calculator, to estimate stroke risk. “Most preceding suggestions used a simpler chance calculator,” January explained. “We advocate a much more detailed threat calculator that gives much more data.”
Yet another important distinction from the earlier guideline is the diminished function of aspirin, which was previously utilised for stroke prevention in lower-danger sufferers.”But information showing that aspirin decreases stroke chance is weak,” mentioned January.
The Guideline for the Management of Individuals With Atrial Fibrillation will be published in the Journal of the American School of Cardiology (www.cardiosource.org), Circulation (www.americanheart.org), and Heart Rhythm (www.hrsonline.org).