Dr. Jean-Yves Le Heuzey,
This main session chaired by J. CAMM (London, UK) and J.Y. LE HEUZEY (Paris, FR) has brought an interesting update concerning specifi c aspects of atrial fibrillation (AF).
The diagnosis of AF may be difficult when the symptoms are not obvious. Important researches are ongoing in order to assess the interest of implantable loop recorders, as pointed out by G. HINDRICKS (Leipzig, DE). Their interest may be emphasized in specific situations like the follow up of patients after ablation, or the decision of anticoagulation.
New antithrombotic drugs are demonstrating their efficacy versus warfarine in stroke prevention. L. WALLENTIN (Uppsala, SE) has shown the main results of RELY, ROCKETAF and ARISTOTLE with Dabigatran, Rivaroxaban and Apixaban, making a comparison between the different parameters studied in all the trials. The main interest of these drugs is that, as compared to warfarin, they induce much fewer intracranial haemorrhages.
I. SAVELIEVA (London, UK) came back on the problem of the strategic choice, i.e. rate or rhythm control. Since the results of the AFFIRM trial, most of the arrhythmologists consider that the goals have to be redefined. The maintenance of sinus rhythm implies a better prognosis but it is necessary to avoid the side effects of drugs prescribed for maintenance or the complications of non-pharmacological techniques.
Finally S. ERNST (London, UK) made a review of abative procedures and their results. Many studies have shown a superiority of ablative techniques as compared to antiarrhythmic drugs but it is necessary to know that most of these studies have been made in patients with a previous failure of antiarrhythmic drugs. New trials comparing anti-arrhythmic drugs and ablation in first intention are ongoing.
New evidence beyond guidelines in atrial fibrillation
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