Uninterrupted VKAs in ablation and device implantation
The European Society of Cardiology (ESC) has recommended uninterrupted anticoagulation with vitamin K antagonists (VKAs) during ablation and device implantation in a position paper presented at the European Heart Rhythm Association Europace – Cardiostim 2015 meeting held recently in Milan, Italy.
Chair of the writing group Professor Christian Sticherling (Universitätsspital Basel, Switzerland) said: “Traditionally we interrupted anticoagulation during device implantation and restarted it afterwards. And we bridged with heparin around the time of the operation. The new recommendation is to continue to give the VKA and perform the operation without any bridging. That shows the lowest rate of perioperative bleeding.”
He added: “Also new is the recommendation not to interrupt VKAs during ablation and particularly during pulmonary vein isolation which is the most common type of ablation nowadays.”
The paper, produced by the EHRA, has been published in Europace (doi: 10.1093/europace/euv190).
Arrhythmias and CKD
The first ESC recommendations for patients with cardiac arrhythmias and chronic kidney disease (CKD) were also presented at the meeting.
“There is increasing awareness in the cardiology community that renal impairment influences how we treat patients with arrhythmias,” said Chair of the writing group Professor Guiseppe Boriani (University of Bologna, Italy). “The introduction of non-vitamin K oral anticoagulants (NOACs) as an alternative to warfarin brought this issue to the fore since renal function determines whether or not they can be prescribed. The ESC decided it was a good time to introduce recommendations.”
The paper, produced by the EHRA, also recommends using estimated glomerular filtration rate (eGFR) as more reliable than serum creatinine for classifying the severity of CKD.
It has been published in Europace (doi: 10.1093/europace/euv202).
Time is muscle in acute heart failure
Urgent diagnosis and treatment in acute heart failure (AHF) has been emphasised for the first time in joint recommendations published in a consensus paper from the Heart Failure Association (HFA) of the ESC, the European Society for Emergency Medicine and the Society for Academic Emergency Medicine in the USA.
“This is the first guidance to insist that AHF is like acute coronary syndrome (ACS) in that it needs urgent diagnosis and appropriate treatment,” said Professor Alexandre Mebazaa, lead author and HFA board member. “By introducing the time to therapy concept together with new medications for AHF we hope to achieve the reductions in mortality and morbidity seen with ACS.”
The consensus paper outlines:
- An algorithm for the management of AHF
- Tests and treatments to be performed pre-hospital, and in the emergency department, coronary care unit (CCU) or intensive care unit (ICU)
- The role of nurses in the management of AHF
- How to use oxygen therapy and ventilatory support
- How to manage new and currently prescribed medicines
- Criteria for discharge from hospital and recommendations for follow up.
The paper has been published in the European Heart Journal (doi: 10.1093/eurheartj/ehs104).
