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An analysis of the biomolecule substudy of the EAST – AFNET 4 trial revealed: biomolecule concentrations in the blood of patients with atrial fibrillation can be used to identify patients at high and low cardiovascular risk. Today the findings were presented by Prof. Larissa Fabritz, University Medical Center Hamburg Eppendorf, Hamburg, Germany, at the Frontiers in CardioVascular Biomedicine Congress in Amsterdam and published in Cardiovascular Research (1).

Atrial Fibrillation (AF) is the most common arrhythmia in elderly people. AF often occurs in patients with cardiovascular comorbidities with shared disease mechanisms. Little is known about the disease processes leading to AF-related complications and their interactions in patients with AF.

In patients with device-detected atrial fibrillation and a high comorbidity burden, oral anticoagulation increases bleeding without a clear reduction in stroke. This is the main finding of a sub-analysis of the NOAH – AFNET 6 trial presented by Dr Julius Nikorowitsch, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany, in a late-breaking science session at the annual congress of the European Heart Rhythm Association (EHRA) in Berlin, Germany, today and simultaneously published in the European Heart Journal (1).

Device-detected atrial fibrillation (DDAF) are short and typically rare episodes of atrial fibrillation (AF) detected by pacemakers, defibrillators, and implanted loop recorders capable of continuous rhythm monitoring. Device-detected atrial fibrillation is found in every fifth patient with a cardiac implanted electronic device (2). Device-detected atrial fibrillation can lead to stroke, but the stroke risk in patients with device-detected atrial fibrillation appears lower than the stroke risk in patients with ECG-documented atrial fibrillation.

An international panel of experts published recommendations to improve management of atrial fibrillation (AF). The position pAn international panel of experts published recommendations to improve management of atrial fibrillation (AF). The position paper summarizes the results of the 9th AFNET/EHRA consensus conference – a two-day expert meeting which was jointly organized by the German Atrial Fibrillation Network (AFNET) and the European Heart Rhythm Association (EHRA) in Münster, Germany, in September 2023. Today the consensus report was presented at the EHRA congress in Berlin by Prof. Dominik Linz, Maastricht, The Netherlands, and simultaneously published in Europace (1).

Atrial fibrillation (AF) is the most common arrhythmia and a growing health problem in an aging society. It affects several million people in Europe and worldwide.

Investigator-initiated trials led by the German Atrial Fibrillation NETwork (AFNET) provide evidence for several recommendations in the 2023 guideline for the diagnosis and management of atrial fibrillation (AF) developed by the American College of Cardiology (ACC) and the American Heart Association (AHA) in collaboration with the Heart Rhythm Society (HRS). The updated guideline has recently been published in Circulation (1).

During the past 20 years, AFNET delivered a set of investigator-initiated trials in the field of atrial fibrillation. The results of these trials now provide evidence for several recommendations in the 2023 American guideline for the diagnosis and management of AF.

The 10 take home messages emphasize the importance of early and continued management of patients with AF that should focus on maintaining sinus rhythm and minimizing AF burden. This new recommendation is based on the results of the EAST – AFNET 4 trial (2). The up-to-date guidance contains the following new recommendation: “In patients with a recent diagnosis of AF (<1 year), rhythm control can be useful to reduce hospitalizations, stroke, and mortality.” (Section 8.1 on rhythm control therapy). This means that early rhythm control therapy should be considered in all patients fulfilling the enrolment criteria of EAST – AFNET 4. Several sub-studies of EAST – AFNET 4 have influenced the recommendations on rhythm control in patients with atrial fibrillation and heart failure, in asymptomatic patients, and in other subgroups.

In patients with device-detected atrial fibrillation the risk of stroke appears low (1% per year) compared to patients with ECG-detected atrial fibrillation, even in patients with long episodes. Anticoagulation can slightly reduce stroke risk, but also increase major bleeding. This is the main finding of a sub-analysis of the NOAH – AFNET 6 trial presented by Dr Nina Becher, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany, in the late-breaking clinical trials session at the annual congress of the American Heart Association (AHA) in Philadelphia, USA, and published on 12th November, 2023, in the European Heart Journal (1).

On 12 and 13 September international experts in atrial fibrillation come together in Münster, Germany, to take part in the 9th AFNET/EHRA consensus conference. “Longer and better lives for patients with atrial fibrillation” is the pronounced intention of the two-day expert meeting which is jointly organized by the German Atrial Fibrillation Network (AFNET) and the European Heart Rhythm Association (EHRA) every two years.

Atrial fibrillation (AF) is the most common heart arrhythmia and a growing health problem in an aging society. It affects several million people in Europe and worldwide.

Prof. Paulus Kirchhof, Hamburg, Germany, one of the four chairpersons of the conference and board member of AFNET, explains the background of the expert meeting: “Despite improved treatment options AF patients still suffer strokes, heart failure, and premature death. There are various approaches to optimize care for AF patients. We set out to bring these approaches together. The AFNET/EHRA consensus conference provides a high-level expert forum to discuss recent advances in AF diagnosis and therapy.”

The clinical trial NOAH – AFNET 6 conducted by the German Atrial Fibrillation Network (AFNET), Münster, Germany, revealed: In patients with atrial high rate episodes (AHRE), but without ECG-documented atrial fibrillation (AF), oral anticoagulation increases bleeding without reducing strokes. Stroke rate was low in patients with AHRE with and without oral anticoagulation. The results were presented today at the annual congress of the European Society of Cardiology (ESC) in Amsterdam and published in the New England Journal of Medicine (1).

Atrial high-rate episodes are short and rare atrial arrhythmias that resemble atrial fibrillation detected by implanted pacemakers, defibrillators, and loop recorders that enable long-term monitoring of heart rhythm. AHRE are found in 10-30% of patients with implanted devices (2). AHRE episodes resemble atrial fibrillation. Therefore, patients with AHRE are often offered treatment with blood thinners (oral anticoagulation) without ECG-documented atrial fibrillation. So far, the efficacy and safety of oral anticoagulation has never been tested in patients with AHRE (2,3).