Our mission is to become a worldwide reference for education in the field for all professionals involved in the process to dissemintate knowledge & skills of Acute Cardiovascular Care
Our mission is to promote excellence in clinical diagnosis, research, technical development, and education in cardiovascular imaging in Europe.
Our mission: To promote excellence in research, practice, education and policy in cardiovascular health, primary and secondary prevention.
Our goal is to reduce the burden in cardiovascular disease in Europe through percutaneous cardiovascular interventions.
Our Mission is "to improve the quality of life of the population by reducing the impact of cardiac rhythm disturbances and reduce sudden cardiac death"
To improve quality of life and logevity, through better prevention, diagnosis and treatment of heart failure, including the establishment of networks for its management, education and research.
Working Groups goals is to stimulate and disseminate scientific knowledge in different fields of cardiology.
ESC Councils goal is to share knowledge among medical professionals practising in specific cardiology domains.
OUR MISSION: TO REDUCE THE BURDEN OF CARDIOVASCULAR DISEASE
Mr Samuel Levy,
Atrial fibrillation (AF) identifies a group of patients at high risk of stroke estimated to be 5-6% per year. Antithrombotic therapy with vitamin K antagonists (VKAs) mainly warfarin reduces by an average of 64% the risk of stroke. The period following cardioversion is at a particular risk for stroke justifying the recommendation of the Guidelines to use VKAs 3 weeks before and 1 month after cardioversion. Dr George Andrikopoulos (Athens, GR) tackled the problem of the duration of anticoagulation following cardioversion and showed that history of stroke and patients >75 years are at a higher embolic risk following cardioversion. He emphasized the high incidence of asymptomatic AF, the phenomenon of left atrial stunning particularly in patients undergoing AF catheter ablation and concluded that anticoagulation with VKAs can be stopped after one year of anticoagulation in patients with CHADS-2 score 0, but in those with a CHADS-2 score of ≥1 anticoagulation can be stopped at 4 weeks or could be continued lifelong. Often the question arises of long-term anticoagulation in patients with sporadic AF episodes. In an extremely well documented presentation Prof. Carina Blomstrom-Lundqvist (Uppsala, SE) reviewed the papers on the effect of the duration and frequency of AF and the so-called “AF burden” as evaluated using implanted devices, which showed that patients with more than 5.5 hours/day have a risk of stroke of 2.4% over a 1.4 year follow-up as compared with 1.1% in those with a burden of less than 5.5 hours/day. Another controversial issue is that of interruption of AVK in patients following a successful catheter ablation of AF. Dr Pratola (Ferrara, IT) suggests on the basis of current data and the possibility of late recurrences and of asymptomatic AF to stick to the use of the CHADS-2 score system for decision making. Percutaneous interventions including stent insertion in patients with AF raise the issue of use of antiplatelet agents alone or with warfarin. Prof Ariel Cohen in a critical review of current literature pointed out that antiplatelet agents are superior to warfarin, while in AF patients, warfarin is superior to antiplatelet agents. AF complicating acute coronary syndrome increases mortality and the risk of stroke and bleeding. Triple therapy (clopidogrel, aspirin and warfarin) may be needed after stent implantation, followed by bitherapy (aspirin + VKAs) for 12 months and then warfarin lifetime. In patients with high risk thromboembolic risk (CHADS-2 ≥2) and low bleeding risk (HASBLED <3), triple therapy is mandatory and efficient, while double therapy is indicated in CHADS-2 0-1 or in case of high bleeding risk. In an outstanding presentation, Prof Thomas Meinertz (Hamburg, DE) reviewed in a real case the various possibilities that we have including catheter ablation, the use of new anticoagulants such as dabigatran and rivaroxaban, and transcutaneous intervention for left atrial appendage occlusion.
Anti-thrombotic therapy in atrial fibrillation: difficult decisions
© 2016 European Society of Cardiology. All rights reserved