Update der ESC-Leitlinie zum Management des Vorhofflimmerns

Abstract

The 2010 Update of the European Society of Cardiology (ESC) guidelines for management of atrial fibrillation have been published. In this Hotline article a short summary is given of these new guidelines. They provide an effective tool for making evidence based decisions on therapy. The guidelines contain a number of new elements. A new type of atrial fibrillation named long-persisting atrial fibrillation has been identified. The guidelines contain recommendations on the use of antithrombotic therapy and heart rate control. A strict antithrombotic therapy with vitamin K antagonist is advised. The guidelines include a series of new scores as the extension of the CHADS₂ via the CHA₂DS₂-VASc-Score for the estimation of thromboembolic risk. There is a further update on the new EHRA Score for the classification of the symptoms of the patients during atrial fibrillation and the HAS-Bled Score assessing the bleeding risk. Based on the results of the RACE II trial the rate control can be adjusted. The trial has shown that in the patients enrolled in RACE II a lenient rate control therapy is reasonable compared to strict rate control under 80 beats per minute. Dronedarone was established in the guidelines as first line therapy. Catheter ablation can be considered as an initial therapy in symptomatic patients with paroxysmal AF and minimal or no heart disease (hypertension and no left-ventricular hypertrophy).

Literatur

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