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.