atrial fibrillation and stroke prevention - Continuing Medical ...
atrial fibrillation and stroke prevention - Continuing Medical ... atrial fibrillation and stroke prevention - Continuing Medical ...
Essentials in Primary Care Conference Wednesday, July 31, 2013 RACE-II Trial • Primary outcome (composite of death from CV causes, hospitalization for heart failure, stroke, systemic embolism, bleeding, lifethreatening arrhythmias) –12.9% lenient control vs 14.9% strict (NS) • No difference in any individual outcome • No difference in hospitalizations or adverse effects • Conclusion: lenient rate control (resting HR < 110) is as effective and easier to achieve Van Gelder IC, et al. RACE II trial. NEJM 2010;362:1363-73. 2011 ACCF/AHA/HRS Focused Update: Strict vs Lenient Control • Class III-No Benefit - Treatment to achieve strict rate control (HR < 80 bpm at rest or < 110 bpm during 6-min walk) is not beneficial compared to achieving a resting HR < 110 bpm in patients with persistent AF who have stable ventricular function and no or acceptable symptoms related to the arrhythmia Wann LS et al. Circulation 2011;123:11144-1150. Jan Basile, MD Atrial Fibrillation & Stroke Prevention
Essentials in Primary Care Conference Wednesday, July 31, 2013 Regardless of your Decision to Achieve Rhythm vs. Rate Control Choice of therapeutic strategy does not affect your decision regarding anticoagulation, i.e., achieving normal sinus rhythm does not allow one to stop anticoagulation-be it by -Antiarrythmic Rx -RF ablation -Cardioversion Asymptomatic Episodes More Common After Catheter Ablation for Atrial Fibrillation (DISCERN)* • Implantable Cardiac Monitor (ICM) placed 3 months before and for a mean of 18 months after RF ablation for AF in 50 pts • The ratio of asymptomatic to symptomatic AF episodes increased from 1.1 to 3.7 (p=0.002) • Post-ablation state is the strongest predictor of asymptomatic AF with 12% of patients having asx recurrences only (DISCERN) Discerning Symptomatic and Asymptomatic Episodes Pre and Post Radiofrequency Ablation of Atrial Fibrillation Verma A et al. Jama Internal Medicine 2013;173 (2):149-156. Jan Basile, MD Atrial Fibrillation & Stroke Prevention
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Essentials in Primary Care Conference<br />
Wednesday, July 31, 2013<br />
RACE-II Trial<br />
• Primary outcome (composite of death from<br />
CV causes, hospitalization for heart failure,<br />
<strong>stroke</strong>, systemic embolism, bleeding, lifethreatening<br />
arrhythmias)<br />
–12.9% lenient control vs 14.9% strict (NS)<br />
• No difference in any individual outcome<br />
• No difference in hospitalizations or adverse<br />
effects<br />
• Conclusion: lenient rate control (resting HR<br />
< 110) is as effective <strong>and</strong> easier to achieve<br />
Van Gelder IC, et al. RACE II trial. NEJM 2010;362:1363-73.<br />
2011 ACCF/AHA/HRS Focused Update:<br />
Strict vs Lenient Control<br />
• Class III-No Benefit<br />
- Treatment to achieve strict rate control (HR < 80<br />
bpm at rest or < 110 bpm during 6-min walk) is not<br />
beneficial compared to achieving a resting HR <<br />
110 bpm in patients with persistent AF who have<br />
stable ventricular function <strong>and</strong> no or acceptable<br />
symptoms related to the arrhythmia<br />
Wann LS et al. Circulation 2011;123:11144-1150.<br />
Jan Basile, MD<br />
Atrial Fibrillation & Stroke Prevention
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