Canadian Journal of Cardiology

Focused 2012 Update of the Canadian Cardiovascular Society Atrial Fibrillation Guidelines: Recommendations for Stroke Prevention and Rate/Rhythm Control

      Abstract

      The Canadian Cardiovascular Society (CCS) published the complete set of 2010 Atrial Fibrillation (AF) Guidelines in the January, 2011 issue of the Canadian Journal of Cardiology. During its deliberations, the CCS Guidelines Committee engaged to a timely review of future evidence, with periodic composition of focused updates to address clinically important advances. In 2011, results were published from 3 pivotal AF trials: the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonist for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET-AF), the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) study, and the Permanent Atrial Fibrillation Outcome Study Using Dronedarone on Top of Standard Therapy (PALLAS), comparing dronedarone with placebo in patients with permanent AF and additional cardiovascular disease risk-factor burden. Each of these large randomized trials provided clear results with major implications for AF management. Other important evidence that has emerged since the 2010 Guidelines includes findings about prediction instruments for AF-associated stroke and bleeding risk, stroke risk in paroxysmal-AF patients, risk-benefit considerations related to oral anticoagulation in patients with chronic kidney disease, and risk/benefit considerations in the use of antiplatelet agents, alone and in combination with each other or with oral anticoagulants, in AF patients. The Guidelines Committee judged that this extensive and important new evidence required focused updating of the 2010 Guidelines with respect to stroke prevention and rate/rhythm control. This report presents the details of the new recommendations, along with the background and rationale.

      Résumé

      La Société canadienne de cardiologie (SCC) a publié l'ensemble des lignes directrices de 2010 en matière de fibrillation auriculaire (FA) dans le numéro de janvier 2011 du Journal canadien de cardiologie. Au cours de ses discussions, le comité des lignes directrices de la SCC s'est engagé à revoir régulièrement les nouvelles données par la rédaction périodique de mises à jour ciblées portant sur les avancées cliniques importantes. En 2011, les résultats de 3 essais pivots sur la FA ont été publiés : le ROCKET-AF ( Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonist for Prevention of Stroke and Embolism Trial in Atrial Fibrillation ), l'étude ARISTOTLE ( Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) et le PALLAS ( Permanent Atrial Fibrillation Outcome Study Using Dronedarone on Top of Standard Therapy), qui compare le dronédarone au placébo chez les patients ayant une FA permanente et des facteurs de risque cardiovasculaire additionnels. Chacun de ces essais hasardisés de grande envergure a fourni des résultats clairs sur les importantes conséquences de la prise en charge de la FA. Les autres données probantes importantes qui sont ressorties depuis la publication des lignes directrices 2010 incluaient les conclusions sur les outils de prédiction du risque d'accident vasculaire cérébral et d'hémorragie associé à la FA, du risque d'accident vasculaire cérébral chez les patients ayant une FA paroxystique, les considérations risques-avantages liés à l'anticoagulation orale chez les patients ayant une maladie rénale chronique (MRC) et les considérations risques-avantages de l'utilisation d'agents antiplaquettaires, seuls ou en combinaison avec d'autres agents antiplaquettaires ou agents anticoagulants oraux, chez les patients ayant une FA. Le comité des lignes directrices a estimé que ces nouvelles données probantes, importantes et exhaustives exigeaient une mise à jour ciblée des lignes directrices 2010 en ce qui a trait à la prévention des accidents vasculaires cérébraux, le maintien du rythme et la maîtrise de la fréquence. Ce rapport présente de manière détaillée les nouvelles recommandations, ainsi que leur fondement et leurs justifications.

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      Linked Article

      • Erratum
        Canadian Journal of CardiologyVol. 28Issue 3
        • In Brief
          In March/April 2012 issue, there was an error in the article “Focused 2012 Update of the Canadian Cardiovascular Society Atrial Fibrillation Guidelines: Recommendations for Stroke Prevention and Rate/Rhythm Control” by Skanes et al. (Can J Cardiol 2012;28:125-36). On page 129, in the second and fourth paragraphs, information provided about AVERROES trial was incorrect. The AVERROES trial included 5599 patients and compared apixaban to ASA only, not apixaban to ASA plus clopidogrel. The corrected paragraphs appear below with changes in bold.
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