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European Society of Cardiology

Clinical Articles, Lead Article


Despite recent advances in the treatment of heart rhythm disturbances, mortality and morbidity rates associated with atrial fibrillation (AF) remain “unacceptably high”, according to a new report presented recently at the European Heart Rhythm Association (EHRA) EUROPACE 2011 congress in Madrid.

The report, prepared jointly by the German Competence Network on Atrial Fibrillation (AFNET) and the EHRA, says AF is emerging as “the new epidemic” in cardiovascular disease.  Improvements in the management of AF can be achieved by several steps, it claims: the detection and better management of risk factors, good clinical use of new antithrombotic therapies, early detection of any new arrhythmia, and timely rhythm control treatment.

The report lists the validated risk factors for AF, as well as less validated and emerging risk factors.  The authors recommend that analysis of several cardiac biomarkers – particularly natriuretic peptides – can help refine the assessment of AF risk. With genetic factors most closely associated with AF in the young, genetic biomarkers may also help assess AF risk, they say.

EUROPACE programme copyHowever, many of the determinants of AF risk remain “elusive”, the report claims, highlighting “a clear and unmet need to identify and characterize factors associated with progression of AF”.  The report finds that although anticoagulants can be potentially life-saving for patients with stroke at risk of AF, the associated risk of severe bleeding makes their administration a balancing act.

Vitamin K antagonists are limited by food interactions, bleeding and monitoring, the report says, suggesting that newer anticoagulants, such as dabigatran, rivaroxaban, apixaban or edoxaban, may overcome some of these difficulties. They are highly effective in clinical trials, but their everyday use has not been tested, authors claim. The report welcomes the introduction of these new therapies, but calls for more information about them, and for careful monitoring of their efficacy in clinical practice.

However, even when anticoagulant therapy is optimally administered, AF patients still fare worse than patients with other cardiovascular conditions, the authors find.  Additional rate and rhythm control therapies, especially when administered early, may be preferred; such a “comprehensive” approach, concludes the report, may well help improve the outcome for AF patients.

While accepting that “continuous oral anticoagulation is the cornerstone of stroke preventing in AF patients”, the report notes that “even on optimal anticoagulant therapy in controlled trials, the residual stroke rate in AF patients remains unacceptably high at approximately 1.5% per year”.

Professor Paulus Kirchhof from the University Hospital Münster in Germany, one of the organisers of Europace 2011 says: “The management of atrial fibrillation is undergoing remarkable changes – new antithrombotic drugs, catheter ablation and new insights into its mechanism. Our consensus report provides initial guidance in the good use of these new – and at times costly – therapeutic options”.


1 ‘Comprehensive risk reduction in patients with atrial fibrillation: Emerging diagnostic and therapeutic options’, based on the third consensus conferences of the European Heart Rhythm Association (EHRA) and the Competence Network on Atrial Fibrillation (AFNET).

Published on: July 12, 2011

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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