Recent advances in the diagnosis and treatment of atrial fibrillation, and what they mean for patients, were considered by a group of around 75 international experts at a three-day meeting that began on Monday.
The 9th biannual Consensus Conference of the German Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA), a branch of the European Society of Cardiology (ESC), was held from 11 to 13 September in Münster, Germany.1
Scientific Committee member and representative for AFNET, Professor Paulus Kirchhof (Hamburg, Germany), said: "Atrial fibrillation is the most common heart rhythm disorder, with a prevalence of between 2% and 4% in adults.2 Despite improved treatment options, patients still suffer strokes, heart failure and premature death. There are various strategies to optimise care for patients with atrial fibrillation and we set out to bring these approaches together. Through a combination of lectures, discussions and break-out groups, AFNET/EHRA Consensus Conferences provide a forum to review the latest state-of-the-art findings on diagnosis and treatment, and discuss how recent advances can be translated into improved clinical care for this growing population."
In many patients, atrial fibrillation is asymptomatic and the first manifestation is a debilitating stroke, heart failure or a blackout. Early diagnosis is important to prevent these complications and the AFNET/EHRA joint conference began with a discussion of the clinical impact of new studies on screening for atrial fibrillation.
Once diagnosed, anticoagulants are prescribed to reduce the risk of stroke and the development of new anticoagulants was explored. This section also covered results from the NOAH-AFNET 6 trial, which were recently published3 simultaneously with a presentation at ESC Congress 2023. The NOAH-AFNET 6 trial assessed the benefits and risks of prescribing anticoagulants to patients with atrial high-rate episodes (AHRE), an area of previous clinical uncertainty.3 Resembling atrial fibrillation, AHRE are short and rare atrial arrhythmias that may occur in patients with implanted cardiac devices, such as pacemakers.3 New data showedthat oral anticoagulation in patients with AHRE increases bleeding without preventing stroke and other cardiovascular events.3 The participants at this week's conference discussed the impact of these findings and those of other new trials, and provided additional clinical context.
Also on the agenda was a section on achieving better rhythm management – where attaining normal sinus rhythm is a priority – to improve patient outcomes, such as reducing symptoms, enhancing quality of life, and reducing the risk of stroke, heart failure, hospitalisation and death from cardiovascular causes. The most appropriate time to switch from rhythm control with drugs to an atrial fibrillation ablation procedure and an implanted pacemaker was debated by the experts. Professor Kirchhof stated: "Since the presentation of the primary results of the EAST-AFNET 4 trial at the digital ESC Congress in 2020 and its simultaneous publication,4 more and more evidence supports a broader use of rhythm control therapy to reduce cardiovascular risk in patients with atrial fibrillation. This evidence was discussed in detail."
In addition to anticoagulation and rhythm management, several other factors should be considered in each patient with atrial fibrillation to ensure they receive optimised care, including whether they have other related conditions such as heart failure or kidney disease, their cardiovascular risk factors, including high blood pressure and an unhealthy lifestyle, and their genetic make-up. These considerations and how to achieve high-quality integrated care were discussed.
New technologies and their role in the future management of atrial fibrillation were the focus of another section of the proceedings. For instance, conventional ablation technology using thermal energy (e.g. heat/radiofrequency energy or cold/cryothermal energy) was compared with newer methods, such as pulsed field ablation using high energy electrical pulses.
"During the conference, we jointly developed recommendations for better atrial fibrillation management and we will summarise these into a position paper for subsequent publication. We hope our results will also be integrated into the upcoming guidelines of the ESC next year," said Professor Andreas Goette (Paderborn, Germany), a Scientific Committee member for AFNET.
Concluding, the scientific organiser on behalf of EHRA, Professor Isabelle Van Gelder (Groningen, The Netherlands), said: "Atrial fibrillation is a fast-moving field. Bringing together experts from around the world to discuss the latest updates helps us to ensure that clinical practice keeps pace with investigational progress. We aim to optimise the current care pathway to help our patients live better and longer lives."
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