AHA/ACC/ESC update AF guidelines
MedWire News: The latest atrial fibrillation (AF) guidelines from the American College of Cardiology (ACC), American Heart Association (AHA), and European Society of Cardiology (ESC) suggest that strict heart rate control in patients with the arrhythmia provides no benefit over a more lenient approach.
The guidelines recommend that a resting heart rate of less than 110 beats per minute (bpm), achieved using a more lenient approach, is an acceptable treatment target in chronic AF patients with stable ventricular function.
This recommendation follows findings from the RACE II (Rate Control Efficacy in Permanent Atrial Fibrillation) trial in which patients undergoing strict treatment to maintain a resting heart rate of less than 80 bpm reported a similar quality of life to those with a resting heart rate of 110 bpm achieved by a lenient approach.
"We don't need to be compulsive about absolute numbers... giving multiple drugs based solely on heart rate," said L Samuel Wann (Wisconsin Heart Hospital, Milwaukee, USA), chair of the document's writing committee.
"Patients with symptoms due to rapid heart action need treatment, and the long-term adverse effects of persistent tachycardia on ventricular function are still of concern," added Wann.
Other recommendations outlined in the document include the addition of clopidogrel to aspirin to reduce the risk for major vascular events in AF patients with contraindications to warfarin therapy.
In addition, the update advocates dronedarone therapy as a measure for reducing the risk for cardiovascular event-related hospitalization in all patients with paroxysmal AF, except for those with New York Heart Association class IV heart failure (HF) or recent (past 4 weeks) history of decompensated HF.
The updated guidelines also feature a change in the indications for catheter ablation in AF.
The 2006 guidelines limited the use of ablation in paroxysmal AF to "symptomatic patients with little or no left atrium enlargement," but the updated guidelines now state that the procedure may be performed even in the presence of "significant left atrial dilatation or significant left ventricular dysfunction."
The guidelines are published in the Journal of the American College of Cardiology, Heart Rhythm, and Circulation.
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By Lauretta Ihonor