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Atrial Fibrillation Guideline Recommendations Updated

Guidelines state that strict heart rate control provides no benefit over more lenient control

TUESDAY, Dec. 21 (HealthDay News) -- Strict control of heart rate among patients with persistent atrial fibrillation with stable ventricle function does not appear to provide any benefit compared to more lenient control, according to new guideline recommendations published online Dec. 20 in Circulation.

L. Samuel Wann, M.D., of the American College of Cardiology Foundation (ACCF) and American Heart Association (AHA), and colleagues provided an update to the ACCF/AHA/European Society of Cardiology 2006 Guidelines for the Management of Patients With Atrial Fibrillation. In the updated guidelines, new recommendations for patients with persistent atrial fibrillation with stable functioning of the ventricles state that strict control of heart rate, at lower than 80 beats per minute at rest and lower than 110 during a six-minute walk, provides no added benefit over more lenient control to achieve a resting heart rate of lower than 110 beats per minute.

Several other updates were made based on advances in the management of atrial fibrillation. In atrial fibrillation patients who are poor candidates for warfarin, a combination of aspirin and clopidogrel may be considered to prevent stroke or other types of blood clots. In addition, while dronedarone may reduce hospitalizations for cardiovascular events related to atrial fibrillation, the drug should not be administered to patients with New York Heart Association class IV heart failure or patients who have had an episode of decompensated heart failure in the past month, especially if they presented with depressed ventricular function. The recommendations also support the use of catheter ablation as a treatment to maintain normal heart rhythm.

"The evidence showed rigid control did not seem to benefit patients," Wann said in a statement. "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."

Several writing group members disclosed financial ties to pharmaceutical and medical device companies.

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