This was an interesting session illustrating the intimate relationship between atrial fibrillation and heart failure, chaired by V. Mareev (Moscow, RU) and G Y H. Lip (Birmingham, GB)
A.J.Camm (London, GB) reviewed the epidemiology and risk prediction for incident atrial fibrillation in heart failure. AF and heart failure represent a vicious cycle. Many comorbidities often coexist, and risk prediction for incident AF is possible.
G.Y.H. Lip (Birmingham) presented on pharmacological management of AF in heart failure. Much of AF management is patient-centred and symptom directed. Whilst we are left very much with amiodarone for rhythm control, a very important consideration is oral anticoagulation (OAC) for stroke prevention. Given that heart failure confers an adverse stroke risk in AF, OAC should be delivered, whether as well controlled warfarin or one of the novel OACs. The lecture finished with presentation of a new score (SAMe-TT2R2), which is a newly described score to predict those who would do well on Vitamin K antagonists (SAMe-TT2R2 score 0-1) or those who are likely to have poor anticoagulation control with VKA (SAMe-TT2R2 score ≥2) where a novel OAC could be a better option.
Table - The SAMe-TT2R2 score for predicting patients that would do well on VKAs, with high Time in Therapeutic Range
*2 of the following: hypertension, diabetes, myocardial infarction, peripheral artery disease, congestive heart failure, previous stroke, pulmonary disease, hepatic or renal disease.
A.S.Manolis (Athens, GR) presented on rhythm control of AF in heart failure, describing when, how and –more importantly – why. He covered aspects from acute AF presentations, to elective cardioversion and drug-related rhythm control.
K.H.Kuck (Hamburg, DE) discussed the role of catheter ablation of AF in the presence of heart failure. Starting with early data on cardiac function changes pre/post ablation, he moved on to clinical data (currently limited) and finished with designs for 2 ongoing randomised trials (CASTLE-AF and AMICA).
S.Homma (New York, USA) discussed how best to anticoagulate, discussing both anticoagulation for heart failure in sinus rhythm (with a review of recent randomised trials on this topic), and what to do when AF develops.
Apostolakis S, Sullivan RM, Olshansky B, Lip GY. Factors affecting quality of anticoagulation control amongst atrial fibrillation patients on warfarin:The SAMe-TT2R2 (sex female, age less than 60, medical history, treatment [interacting drugs, eg amiodarone for rhythm control], tobacco use [doubled], race [doubled] score. Chest.2013. doi:10.1378/chest.13-0054
Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, Hindricks G, Kirchhof P. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation--developed with the special contribution of the European Heart Rhythm Association. Europace. 2012;14(10):1385-413.