Updated AF guidelines support use of RF ablation

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 - EKG, heart

Updated recommendations for the treatment of nonvalvular atrial fibrillation now call for the use of radio frequency ablation as a treatment, a joint American Heart Association, American College of Cardiology and Heart Rhythm Society panel wrote in its 2014 guidelines issued March 28.

The recommendations include the use of new anticoagulants in addition to warfarin and a smaller role for aspirin in patients with atrial fibrillation. The joint panel also supports the use of a more comprehensive calculator to estimate stroke risk.

The panel found that there is evolving evidence in support of radio frequency ablation to manage paroxysmal atrial fibrillation in younger patients with little to no structural heart disease and in procedures performed in centers with substantial procedural experience.

"The efficacy of radiofrequency catheter ablation for maintaining sinus rhythm is superior to current antiarrhythmic drug therapy for maintenance of sinus rhythm in selected patient populations," the panel wrote.

The recommendations also call for the use of three new anticoagulants in addition to warfarin for some patients with atrial fibrillation. Evidence from clinical trials suggests that dabigatran (Pradaxa, Boehringer Ingelheim), rivaroxaban (Xarelto, Janssen) and apixaban (Eliquis, Bristol-Myers Squibb) have more predictable pharmacological profiles, fewer drug-drug interactions, no dietary interactions and a lower risk of intracranial bleeding than warfarin.

The panel found that the available evidence does not support the use of aspirin in patients with low stroke risk, a preventive strategy recommended by the previous guidelines.

Additionally, the panel recommends replacing the CHADS2 risk calculator with the more comprehensive CHA2DS2-VASc score. The CHA2DS2-VASc score includes a broader score range (0 to 9) as well as more risk factors (female sex, 65 to 74 years of age and vascular disease).

The guidelines were published in Circulation, the Journal of the American College of Cardiology and Heart Rhythm and were developed in conjunction with the Society of Thoracic Surgeons.