2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation

Abstract

The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF Guidelines recommendations, from 2010 to the present 2016 Focused Update.

Fibrilación auricular: enfoque para el médico no cardiólogo

“…La FA es la arritmia supraventricular más frecuente en el ser humano y se caracteriza por la pérdida de la actividad auricular eléctrico-mecánica organizada (1,4,5,8,9,14). Sus características electrocardiográficas diagnosticas son: la ausencia de una onda p sinusal, línea de base irregular, presencia de un intervalo R-R variable, frecuencia cardiaca auricular variable entre 350 a 600 latidos por minuto (lpm) y complejos QRS estrechos (< 120 milisegundos), en ausencia de otras alteraciones de la conducción; pudiendo presentarse como taquicardia de complejos QRS anchos (> 120 milisegundos) en pacientes con bloqueos de rama o conducción infrahisiana aberrante.…”

“…Sus características electrocardiográficas diagnosticas son: la ausencia de una onda p sinusal, línea de base irregular, presencia de un intervalo R-R variable, frecuencia cardiaca auricular variable entre 350 a 600 latidos por minuto (lpm) y complejos QRS estrechos (< 120 milisegundos), en ausencia de otras alteraciones de la conducción; pudiendo presentarse como taquicardia de complejos QRS anchos (> 120 milisegundos) en pacientes con bloqueos de rama o conducción infrahisiana aberrante. Clínicamente puede ser asintomática o cursar con síntomas inespecíficos como disnea de esfuerzos, palpitaciones, angina o sincope (1,4,5,8,9,14). La mayoría de veces el diagnostico se hace mediante realización de electrocardiograma en el contexto de sus complicaciones (ECV, embolismo sistémico, IAM o falla cardiaca) (1,2,4,5,(7)(8)(9)14).…”

“…Su prevalencia se multiplica con la edad y es un factor de riesgo directo para enfermedad cerebrovascular (ECV), insuficiencia cardiaca, infarto agudo de miocardio (IAM) y muerte (1)(2)(3)(4)(5)(6)(7)(8)(9)(10).…”

“…Las últimas guías de práctica clínica en fibrilación auricular de diferentes latitudes enfatizan la importancia de un diagnóstico oportuno y manejo mediante un programa interdisciplinario centrado en el paciente (1,4,5,10,12,13).…”

Left atrial appendage isolation in atrial fibrillation catheter ablation: A meta‐analysis

“…Takahashi et al13 originally identified the LAA as a trigger and substrate for AF maintenance after pulmonary vein isolation (PVI), with several case reports and case series confirming this proarrhythmic role 14, 15, 16. Studies have demonstrated the feasibility of targeting the LAA during catheter ablation17, 18 and during surgical ablation19, 20 with current guidelines recommending closure of the LAA during surgical AF ablation 21. Ligation of the LAA by the LARIAT suture delivery device has also been shown to reduce LAA voltage and capture during pacing22 as well as AF burden 23.…”