December 27, 2010
American Heart Association New Recommendations
(Ivanhoe Newswire) "“ The American Heart Association's new recommendations say that strictly controlling the heart rate of patients with atrial fibrillation provides no advantage over more lenient heart rate control.
Atrial fibrillation is an irregular heart rhythm that occurs when the heart's two upper chambers beat erratically, causing the chambers to pump blood rapidly, unevenly, and inefficiently. Blood can pool and clot in the chambers, increasing the risk of stroke or heart attack. More than 2 million Americans live with the condition.
The heart rate recommendation states that strict treatment to control a patient's heart rate (at less than 80 beats per minute at rest and less than 110 during a six-minute walk) is not beneficial over a more lenient approach to achieve a resting heart rate of less than 110 in patients with persistent, or continuous, atrial fibrillation with stable functioning of the ventricles, (the heart's lower chambers).
"The evidence showed rigid control did not seem to benefit patients," L. Samuel Wann, M.D., chair of the focused update writing group and director of cardiology at the Wisconsin Heart Hospital in Milwaukee, was quoted as saying. "We don't need to be as compulsive about absolute numbers, particularly doing exercise tests and giving multiple drugs based solely on heart rate. Patients with symptoms due to rapid heart action need treatment, and the long term adverse effects of persistent tachycardia on ventricular function are still of concern."
The evidence-based updates include Clopidogrel, Dronedarone, and Catheter Ablation. Clopidogrel is a combination of aspirin and clopidogrel, and could prevent stroke, and blood clots in atrial fibrillation patients. Dronedarone could reduce hospitalizations for cardiovascular events related to atrial fibrillation. Dronedarone should not be given to patients with NYHA class IV heart failure or patients who have had an episode of decompensated heart failure in the past 4 weeks, especially if they have depressed ventricular function. Catheter Ablation is now recommended as a treatment to maintain normal heart rhythm. "Catheter ablation is one of the most rapidly growing procedural areas in cardiology right now, and the evidence does support that," Wann said.
SOURCE: The American Heart Association, Circulation: Journal of the American Heart Association, the Journal of the American College of Cardiology, and HeartRhythm Journal, published online December 2010