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When things go bad: complications in management of atrial fibrillation


Management of atrial fibrillation (AF) is complex and consists of several treatment modalities. Their use may be associated with complications. 

Dr Eckhardt from Munster discussed complications of electrical cardioversion. Besides some rare complications such as sternal fracture and skin burns, there is an increased risk of triggering ventricular fibrillation when the shock is not properly synchronized. The occurrence of bradyarrhythmias after cardioversion is low (below 1%) and the risk of thromboembolism is also in the same range when guidelines are properly applied.

Dr Rosenqvist from Stockholm reviewed the ugly face of anticoagulation therapy in AF patients. He emphasized the dilemma of balancing between risk of thromboembolism (CHA2DS2-VASc score) and bleeding (HAS-BLED score). In the setting of ablation, the strategy of uninterrupted warfarin appears to be associated with significantly less bleeding complications. Uninterrupted use of novel anticoagulants is still controversial.

Dr Hohnloser from Frankfurt evaluated the risks of anti-arrhythmic therapy in AF patients. These include hemodynamic deterioration, pro-arrhythmic effects (bradycardia, torsade de pointes, atrial flutter with rapid ventricular conduction) and drug-to-drug interactions. Using example of dronedarone, he explained the dark side of drug development with opposite outcome results (ATHENA and PALLAS studies).

Dr Cappato from Milan analyzed complication rates of catheter ablation for AF. In two voluntary retrospective registries that collected data between 1995 and 2002 and 2003-2006, data showed that no decrease in complication rates was documented. In addition, data suggest that complication rates were lowest in centers that performed more than 300 AF cases per year.

In summary, the session reviewed the most important risks of different management strategies in AF.


Session Title: When things go bad: complications in management of atrial fibrillation

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.