Some Game Changers in New AFib Guidelines

Best treatment options for atrial fibrillation updated

stethoscope with heart

Doctors may be adding new drug options, using less aspirin and more radio frequency ablation to treat atrial fibrillation patients as a result of comprehensive new guidelines for the medical and surgical treatment of this common heart problem.

“If I were a patient with afib, these guidelines should make me feel a lot better. This document is important and very good,” said Oussama Wazni, MD, Director of the Outpatient Electrophysiology Department and Co-Director of the Ventricular Arrhythmia Center. “As a physician, it also gives a lot more direction,” he said.

The American Heart Association, American College of Cardiology and the Heart Rhythm Society, in collaboration with the Society of Thoracic Surgeons, developed the new guidelines after experts reviewed clinical findings, researched results and many other documents. Experts updated the previous document in 2011. Some changes are subtle; others are potential game changers in treatment.

Atrial fibrillation basics

Atrial arrhythmias originate in the upper (atrial) chambers of the heart. Many impulses begin and spread through the atria, creating a rhythm that is disorganized, rapid and irregular. Because the impulses are traveling through the atria in a disorderly fashion, heart contraction loses its usual rhythm.

Patrick Tchou, MD, Co-director of Cleveland Clinic’s Ventricular Arrhythmia Center and Associate Section Head of the Section of Electrophysiology and Cardiac Pacing, collaborated on the new guidelines. In a whiteboard video, Dr. Tchou describes atrial arrhythmia in more detail.

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Main changes in treatment

The 2014 guidelines direct doctors to act on four main changes in the approach to treatment of atrial fibrillation.

1. Increased emphasis and use of radio frequency ablation for non-valvular atrial fibrillation (rhythm disorders that do not occur because of valve disease)

In an ablation procedure, doctors create scars that block any inappropriate impulses firing from the treated areas. “This document does a very good job of taking all the data we have and all the evidence that’s in the literature about ablations. We’ve been seeing a trend that if a patient is very symptomatic and medications have failed to control their afib, then an ablation is warranted,” Dr. Wazni said.

2. Inclusion of three new anticoagulant drugs in the treatment of non-valvular atrial fibrillation

Previous guidelines recommended only warfarin. The new drugs, dabigatran, rivaroxaban and apixaban, might have benefits for certain patients. “Evidence and studies show some of these new anticoagulants are more effective than Coumadin (warfarin), so if they’re not more effective, they’re as effective and safer from a bleeding standpoint. It’s important to have these new medications in our repertoire for our patients because I believe they improve safety, and the document provides clear guidelines on who to prescribe the newer anticoagulants,” said Dr. Wazni.

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3. A diminished role of aspirin as a preventive treatment for patients with atrial fibrillation

“As we know from past experience, aspirin is not very effective in stroke prevention and it can cause bleeding. This document does a very good job at guiding physicians and patients on when it’s appropriate to use aspirin and when it’s not. There is less dependence now on using aspirin,” Dr. Wazni said.

4. Creation of a new risk calculator for complications due to atrial fibrillation

“This document goes into a more granular calculation of the risk of stroke,” Dr. Wazni said, adding that the new score incorporates some more information about the patient into the risk calculator. “It’s going to be very beneficial to patients because if we have a better idea of their stroke risk, then we can prevent and manage it better.”

The 2014 Guideline for the Management of Patients with Atrial Fibrillation appears in the Journal of the American College of Cardiology, Circulation and HeartRhythm.

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  • sealover

    what is recommended for af caused by a heart valve

    • The_Beating_Edge_Team

      It depends on what is going on with your valve. If your valve is bad and requiring surgery, then afib and valve can be treated at the same time during the procedure. If your valve disease is only mild – they may treat the atrial fibrillation with medications and/or ablation. It depends on the patient. Please contact our nurses if you would like to discuss further. betsyRN

  • jackie

    Ablation is just a pc way of saying burn the inside of your heart. It’s rarely a permanent success and requires a lengthy anaesthesia. Main benefit is to the doctor and hospital finances… One of many unsuccessful ablation patients.

    • The_Beating_Edge_Team

      Jackie – I am sorry your ablation was not successful. It is not for all people and many patients require more than one ablation to achieve success. In a recent web chat – Dr. Baranowski stated – Success rate of afib ablation depends on a variety of factors – including – atrial fibrillation pattern (Paroxysmal vs. persistent); the duration of your afib diagnosis; and very importantly the size of the top chamber of your heart, atrium. Ideal candidates who have not had atrial fibrillation for very long, normal heart chamber size with paroxysmal afib, the success rate is about 75%. This rate can increase up to 90% if up to two ablation procedures are pursued. Hope this helps. Let us know if we can help you. Sincerely, betsyRN

      • jackie

        Thanks for reply. Mine was persistent and permanent. Had it for 2 years with 6 de-fib shock treatments.. Normal rhythm lasting about 6wks. Chamber normal. Ablation of heart and around the opening to pulmonary artery. No luck. Returned to A-fib in hospital. I now have a pacemaker. Wd LOVE normal rhythm so could remove it. But the truth is that nobody knows what initiates a-fib. Nor why ablation works or fails.
        Pretty iffy odds for very hectic surgical procedure?

  • juli

    I have PVC’s. 22% on a an EKG. I had an unsuccessful ablation. Dr said the PVC ‘s are coming from center of heart . Can’t be reached. Tried 7 medications, none worked or side effects were too severe. Is this the same as afib?

  • Joann Busch

    I’ve been I and out of a fib for about 6 years cardio one time now in atro fib can’t get out would it be advisable for me to do ablation or pace maker

  • kristinae

    My husband was recently diagnosed with AFib. Had one cardioversion and went back into AFib within a week. Also was tested for sleep apnea, which he certainly has, and was tested for it but with a faulty air line! They want a “follow up” to be done which we will NOT do until the equipment is fixed. Stupid.
    My grave concern is that my husband sleeps ALL DAY. he can make a simple breakfast then go back to nap for hours and eventually he will retire to his bed and sleep for more hours. This is NOT his usual manner of being. And I worry about stroke. He is on blood thinners. But he is putting on more weight, sleeping constantly is angry hurt frustrated tired and exhausted all the time.
    This is very bad medicine.
    I can’t seem to get anyone in his care circle to care about this. We just get more appointments with technicians. Longer waits for interpretations which tell us nothing. And MORE procedures that do nothing.
    Can you even begin to help me? No one seems to give a whoot. It’s all about the numbers. We were even told that the Dr had sooooo many patients that she couldn’t be counted on to call us back to discuss our concerns. We got a technician instead. Given the money we pay for insurance doctors and mediceines, I expect to see the doctor.
    I am so frustrated and so afraid for my husband.
    Perhaps you can set me on another path and get us some help.
    Thank you