Dr. Germanas Marinskis,
View the Slides from this session in ESC Congress 365
The symposium ‘Closing the mortality gap in atrial fibrillation’, held Saturday morning was dedicated to several aspects of morbidity and mortality in patients with this frequent arrhythmia. The auditorium was nearly full.
The first presentation by professor A.J. Camm was somewhat provocative – the results of several trials showed that nurse-led atrial fibrillation clinics may not only significantly decrease waiting lines for cardioversion, but also decrease complication rates and mortality in AF patients when compared to usual practice of clinics lead by cardiac electrophysiologists.When asked what the reasons for such a difference could be, professor Camm answered that maybe nurses do their work more precisely, are not distracted by other appointments or cases in electrophysiology labs or the need to answer emails.Until we have results of the trials comparing specialized AF clinics against usual care in patients with AF (like RACE 4 that will complete in late 2016), the best thing that we can do is to take an individualized approach to AF patients, promptly making decisions about the need to change treatment strategies if the symptoms of AF are not corrected.
The following presentation (E. Marijon) showed that we have a growing epidemic of AF, with some 33 million affected individuals worldwide, and 5 million new cases each year. Beyond the stroke mortality, AF is related to increased likelihood of myocardial infarction, sudden cardiac death and heart failure.
The relationship between AF and heart failure was discussed in more detail by I.C. Van Gelder. Both their presentations showed that AF is often accompanied by a one or more additional diseases, both cardiac and non-cardiac. And most probably, the term of ‘lone AF’ is not correct, because in almost every patient we can find a disease that may be related to atrial fibrillation. Just a few slides were dedicated to the influence of changing the life habits of the patients – and indeed, we gain more and more evidence that in some patients, AF can be the result of their lifestyle, obesity and insufficient physical activity. And if this is true, a healthier lifestyle could be one efficient, less risky and less expensive way to decrease the burden of atrial fibrillation.
The final presentation by P. Kirchhof analyzed if we can improve outcomes in patients with AF by early interventions aimed at controlling the rhythm. This seems to need more solid results from ongoing and future trials (like EAST – AFNET 4) comparing ablation to the more traditional practices that we still use with the majority of our patients.
Closing the mortality gap in atrial fibrillation
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