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Innovation in atrial fibrillation therapy.

Atrial Fibrillation

LA imaging
Dr Rigolingave an overview of the different echo techniques, the classical and the modern way to assess LA size and function. She showed that left atrial (LA) volumes and function, as evaluated by the reservoir, conduit and contractile phasic changes, have important additional and incremental prognostic value to predict occurrence of cardiac events, including atrial fibrillation recurrence.Strain imaging by Doppler or by speckle tracking have shown incremental value in identifying patients with recurrence of atrial fibrillation.
Innovation in Atrial Fibrillation Therapy
Dr Cohen gave a very complete talk on thromboembolic risk assessment, including theCHA2DS2-VASc score. He also described a new approach to predicting thromboembolicrisk using the mechanical properties of the left atrium.He underlined that some patients with low CHADS score (e.g. 0) need no treatment, while patients with a CHADS score =2 need anticoagulation. Patients with CHADS2  score= 1 are a challenge. The Guidelines recommendanticoagulation, but this population should be better stratified using echo parameters (LAVi, Strain, LVEF) in order to discriminate patients at higher risk needing anticoagulation.
Imaging in left atrial appendage closure
Imaging helps in the selection of patients for left atrial appendage closure. Patientswho are candidatesfor this procedure are those with atrial fibrillation and contraindications for anticoagulation, or those with embolic complications despite full anticoagulation therapy. There is a role for echo before, during and after procedure. Echo beforethe procedure aims to identify the correct indications: low appendage function as expressed by low flow,contrast echo and left atrial appendage dilatation. On the other hand, echo will also make it possible to exclude patients with thrombus in the left atrial appendage,or membrane insidethe left atrial appendage. Before the procedure, echo will also provide anatomical characteristics of the LAA entrance, depth and diameters. During the procedureTEEcan guide the septal puncture and the appropriate positioning of the device. Post procedure,echo can evaluate the position,complications,and thrombus formation on device.
Update in atrial fibrillation therapy
Dr Echahidi provided a nice update on AF treatment.He said that there are two mandatory types of treatments, namely anti-thrombotic and anti-arrhythmic drugs. Anti-thrombotics are now mainly warfarin and NOACs, but most studies have shown superiority of NOAC over warfarin in terms of benefit in survival,despite a higher rate of gastro intestinal bleeding. Anti-arrhythmic drugs have very small benefit when compared to catheter ablation. This later technique can now be offered to many patients with paroxysmal symptomaticAF as first line therapy, according to the recent recommendations.The success rate is about 75 %.
This session’s main interest was the presentation of clinical cases in which the audience was very involved.Atrial fibrillation remains the most common arrhythmia in the world.  In the treatment of this pathology, it is necessary to have collaboration between cardiology subspecialitiest o choose the best option for our patients.




Innovation in atrial fibrillation therapy.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.