ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation–executive summary. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation)

Abstract

Copies: This document is available on the World Wide Web sites of the American College of Cardiology (www.acc.org), the American Heart Association (www. americanheart.org), and the European Society of Cardiology (www.escardio.org). Single and bulk reprints of both the online full-text guidelines and the published executive summary (published in the August 15, 2006, issues of Circulation and the Journal of the American College of Cardiology and the August 16, 2006, issue of the European Heart Journal) are available from Oxford University Press by contacting Special Sales

Atrial Fibrillation After Cardiac Surgery: Incidence, Risk Factors, and Economic Burden

“…Cardioversion was begun at 200 J and was performed according to American College of Cardiology recommendations. 16 In-hospital costs were obtained from the hospital's financial accounting department. All billed items associated with the occurrence of POAF were assigned to one of the following categories: anesthesia: cost of anesthetics, equipment, and disposables used by anesthesiologists during electric cardioversion; intensive care unit: cost/day of nursing, equipment, and space in the ICU (total ϭ cost/d ϫ number of extra days); subintensive care unit ؉ward: cost of nursing, equipment, and space in the subintensive care unit and in the ward (total ϭ cost/d ϫ number of extra days); laboratory: cost of blood tests; cardiology laboratory: cost of electrocardiograms and echocardiograms; pharmacy: cost of pharmacy; therapies: cost of physical and occupational therapies; and others: unknown and nonspecified costs.…”

Sinus Rhythm Restoration and Treatment Success: Insight From Recent Clinical Trials

“…53 Atrioventricular nodal ablation for the control of ventricular response is typically reserved for patients in whom sinus rhythm cannot be restored and rate control is inadequate with pharmacologic therapy. 54 Current guidelines describe catheter-directed, left atrial ablation as a second-line option for the treatment of 53,54 Because fewer patients are candidates for surgical ablation, which is highly invasive, surgical procedures are not discussed here. Some patients appear to be more likely to derive benefit from catheter-directed, left atrial ablation than others.…”

“…53 Atrioventricular nodal ablation may be appropriate in patients with a rapid ventricular response to AF in whom sinus rhythm cannot be restored with antiarrhythmic drug therapy. 54 Potential benefits include improved exercise duration, LVEF, symptoms, and quality of life, and reduced health care use. 66 Disadvantages include the need for permanent pacing and long-term anticoagulation.…”

“…66 Disadvantages include the need for permanent pacing and long-term anticoagulation. 54 A detailed review of atrioventricular nodal ablation is beyond the scope of this review.…”

“…Immediate direct-current cardioversion is the recommended approach for patients with AF involving preexcitation when very rapid tachycardia or hemodynamic instability is present. 54 Moreover, it may be considered when pharmacologic measures fail to promptly correct a rapid ventricular response in patients with ongoing myocardial ischemia, symptomatic hypotension, angina, or heart failure, and in patients for whom AF symptoms are perceived as unacceptable. Pharmacologic cardioversion is simple to administer and most effective when performed within 7 days of AF onset.…”