CardioExchange Archive

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. Among other features, the 2014 Guideline for the Management of Patients With Atrial Fibrillation incorporates important new information about the new oral anticoagulants and catheter ablation for the treatment of AF symptoms.

Perhaps the biggest change since the previous 2006 guideline has been the introduction of new oral anticoagulants, which can be used in some patients instead of warfarin for stroke prevention. The new guideline includes recommendations for the use of dabigatran, rivaroxaban, and apixaban. Warfarin continues to be indicated for the treatment of AF in patients who have mechanical heart valves. The new agents are strongly recommended for use in patients with nonvalvular AF who are unable to maintain a therapeutic INR level with warfarin.

Catheter ablation also gets a strong recommendation when a rhythm control strategy is desired in patients with symptomatic AF refractory to at least one antiarrhythmic drug. “As experience with RF ablation grows, there has been an increased recognition that it can be used effectively as an atrial fibrillation treatment,” said  Craig T. January, the writing committee’s chair, in a press release.

January also highlighted as significant the guideline’s recommendation to use a more comprehensive thromboembolic risk calculator, the CHA2DS2-VASc calculator, to estimate stroke risk. “Most previous guidelines used a simpler risk calculator,” January said. “We recommend a more detailed risk calculator that provides more information.”

Another important difference from the earlier guideline is the diminished role of aspirin, which was previously used for stroke prevention in low-risk patients.”But data showing that aspirin decreases stroke risk is weak,” said January.

The Guideline for the Management of Patients With Atrial Fibrillation will be published in the Journal of the American College of Cardiology (www.cardiosource.org), Circulation (www.americanheart.org), and Heart Rhythm (www.hrsonline.org).