Updated Guidelines for Managing Atrial Fibrillation

Atrial fibrillation (AF), the most common cardiac arrhythmia, affects 2.2 million Americans and is reaching epidemic proportions since its prevalence grows as the older population continues to increase. AF is a major risk factor for stroke if it is not appropriately diagnosed and managed. Updated guidelines on the management of patients with AF were jointly released by the American College of Cardiology, the American Heart Association, and the Heart Rhythm Society in the December 2010 Journal of the American College of Cardiology. “The guidelines reflect a consensus of expert opinion and a thorough review of clinical research,” explains L. Samuel Wann, MD, MACC, FAHA, who chaired the expert group writing committee. “The new recommendations update guidelines that were previously released in 2006. They are based on evidence from clinical trials, as well as expert opinion. The update was precipitated by several new areas of research that have recently become available.” Major Modifications to Atrial Fibrillation Recommendations Several major modifications were offered in the updated guidelines for AF, one of which focuses on heart rate control (Table 1). The RACE II study was one of the primary reasons for revising the guidelines on heart rate control. It found that a strict heart rate control regimen with exercise testing provided no benefit over a more lenient heart rate control regimen. “This is an important modification because it means that physicians won’t need such rigid heart rate reevaluations, which often require exercise tests and the use of multiple drugs,” says Dr. Wann. “Symptomatic patients, however, do require treatment, and the long-term adverse effects of persistent tachycardia on ventricular function are still of concern.”...