Atrial Fibrillation

Evidence Based Reports

Micra™ Transcatheter Pacing System for atrial fibrillation and bradycardia (2014)[National Horizon Scanning Centre] NEW

Nanostim Leadless Pacemaker for atrial fibrillation and bradycardia (2014)[National Horizon Scanning Centre] NEW

Diagnostic Technology: Hand-held ECG monitors for the detection of atrial fibrillation (AF) in primary care (2013) [MaDOX] NEW
 

WatchBP Home A for opportunistically detecting atrial fibrillation during diagnosis and monitoring of hypertension (2013)[NICE] NEW

Apixaban for preventing stroke and systemic embolism in people with nonvalvular atrial fibrillation (2013)[NICE] NEW

 

Percutaneous balloon cryoablation for pulmonary vein isolation in atrial fibrillation (2013)[NICE] NEW

Stroke Prevention in Atrial Fibrillation (2013)[AHRQ] [Executive Summary] NEW
 

Treatment of Atrial Fibrillation (2013)[AHRQ][Executive Summary] NEW
 

Combined anticoagulation and antiplatelet therapy for high-risk patients with atrial fibrillation: a systematic review (2013) [NIHR HTA] NEW

Echocardiography in newly diagnosed atrial fibrillation patients: a systematic review and economic evaluation (2013) [NIHR HTA] NEW

Factor Xa inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in patients with atrial fibrillation (2013) [Cochrane] NEW

Fish oil and atrial fibrillation after cardiac surgery: a meta-analysis of randomized controlled trials (2013)[DARE] NEW

Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials (2013)[DARE] NEW

Novel oral anticoagulants in atrial fibrillation: a meta-analysis of large, randomized, controlled trials vs warfarin (2013)[DARE] NEW

Dabigatran in Atrial Fibrillation Question and Answers document to inform commissioners (2013)[West Midlands Clinical Support Unit] NEW

Dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation (2012)[NICE] NEW

Dabigatran texilate - for stroke prevention in patients with atrial fibrillation (2012)[MTRAC] NEW

Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation(2012)[NICE] NEW

Rivaroxaban (Xarelto) - for stroke prevention in patients with non-valvular atrial fibrillation (2012)[MTRAC] NEW

Dabigatran for Stroke Prevention in Atrial Fibrillation: A Review of the Evidence on Safety (2012)[CADTH] NEW

 

Comparative effectiveness of warfarin and new oral anticoagulants for the management of atrial fibrillation and venous thromboembolism: a systematic review (2012)[DARE] NEW

 

Thoracoscopic exclusion of the left atrial appendage (with or without surgical ablation) for non-valvular atrial fibrillation for the prevention of thromboembolism (2011)[NICE]

Percutaneous endoscopic catheter laser balloon pulmonary vein isolation for atrial fibrillation (2011)[NICE]

Effect of statins on atrial fibrillation: collaborative meta-analysis of published and unpublished evidence from randomised controlled trials (2011)[DARE]

Dronedarone increases the risk of heart failure, stroke and death compared to placebo in people with permanent AF (2011)[MeReC Rapid Review]

Modelling study finds no net benefit from aspirin plus clopidogrel versus aspirin alone in people with AF unable to take warfarin (2011)[MeReC Rapid Review]

Dronedarone for the treatment of atrial fibrillation (2011)[MTRAC]

Atrial fibrillation (chronic)(2011)[Clinical Evidence]Athens Log-in required

Atrial fibrillation (acute onset) (2010) [Clinical Evidence] Athens Log-in required

Atrial fibrillation (2010)[WeMeReC]

Percutaneous occlusion of the left atrial appendage in non-valvular atrial fibrillation for the prevention of thromboembolism (2010)[NICE]

Dronedarone for the treatment of non-permanent atrial fibrillation (2010)[NICE]

Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation (2010) [Cochrane]

Systematic review and cost effectiveness evaluation of 'pill-in-the-pocket' strategy for paroxysmal atrial fibrillation compared to episodic in-hospital treatment or continuous antiarrhythmic drug therapy (2010)[NIHR HTA]

Statins for prevention of atrial fibrillation after cardiac surgery: a systematic literature review (2010)[DARE]

Warfarin vs. Aspirin For Atrial Fibrillation Stroke Prevention (2010)[theNNT]

Warfarin for Atrial Fibrillation Stroke Prevention (2010)[theNNT]

Percutaneous (non-thoracoscopic)epicardial catheter radiofrequency ablation for atrial fibrillation (2009)[NICE]

Catheter ablation for paroxysmal and persistent atrial fibrillation (2009)[Cochrane] NEW

Thoracoscopic epicardial radiofrequency ablation for atrial fibrillation (2009)[NICE]

Comparative effectiveness of radiofrequency catheter ablation for atrial fibrillation(2009)[DARE]

A systematic review of randomized trials comparing radiofrequency ablation with antiarrhythmic medications in patients with atrial fibrillation (2009)[DARE]

Intravenous magnesium sulphate and sotalol for prevention of atrial fibrillation after coronary artery bypass surgery: a systematic review and economic evaluation (2008) [NCCHTA]

Curative catheter ablation in atrial fibrillation and typical atrial flutter: systematic review and economic evaluation (2008)[NCCHTA]

Catheter ablation vs antiarrhythmic drug therapy for atrial fibrillation: a systematic review (2008)[DARE]

Is pulse palpation helpful in detecting atrial fibrillation: a systematic review (2006) [DARE]

Percutaneous radiofrequency ablation for atrial fibrillation (2006) [NICE]

Percutaneous occlusion of the left atrial appendage for atrial fibrillation (2006) [NICE]

High-intensity focused ultrasound for atrial fibrillation in association with other cardiac surgery (2006) [NICE]

Radiofrequency ablation for atrial fibrillation in association with other cardiac surgery (2005) [NICE]

Microwave ablation for atrial fibrillation in association with other cardiac surgery (2005) [NICE]

Cryoablation for atrial fibrillation in association with other cardiac surgery (2005) [NICE]

Pharmacological cardioversion for atrial fibrillation and flutter (2005) [Cochrane]

Electrical cardioversion for atrial fibrillation and flutter (2005) [Cochrane]

Antiplatelet therapy for preventing stroke in patients with non-valvular atrial fibrillation and no previous history of stroke or transient ischemic attacks (2005) [Cochrane]

Anticoagulants versus antiplatelet therapy for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischemic attack (2004) [Cochrane]

Oral anticoagulants for preventing stroke in patients with non-valvular atrial fibrillation and no previous history of stroke or transient ischemic attacks (2004) [Cochrane]

Anticoagulants for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischaemic attack (2003) [Cochrane]


Clinical Guidelines

Atrial Fibrillation (AF)(2013) [Map of Medicine] updated

Guidelines for the management of atrial fibrillation (2010) [ESC]

Atrial Fibrillation (2009) [CKS]

Atrial Fibrillation: The management of Atrial fibrillation (2006) [NICE] update expected in 2014



Recent articles in core journals

Outcomes of apixaban vs. warfarin by type and duration of atrial fibrillation: results from the ARISTOTLE trial (2013) [Eur Heart Journal] NEW

Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: first results of the North American Arctic Front (STOP AF) pivotal trial (2013) [J Am Coll Cardiol] NEW

Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial (2013) [JAMA] NEW

Subclinical atrial fibrillation and the risk of stroke (2012)[NEJM] NEW

Atrial fibrillation (2012)[Lancet] NEW

In the clinic. Atrial fibrillation (2010)[Ann Intern Med]

Effect of age on stroke prevention therapy in patients with atrial fibrillation: the atrial fibrillation investigators (2009) [Evidence Updates]

Development of a risk score for atrial fibrillation (Framingham Heart Study): a community-based cohort study (2009) [Lancet]




eTextbooks

Atrial fibrillation: diagnosis and management (2011)[BMJ Learning]



Clinical Queries

A patient has a history of coronary artery disease and bypass graft and is taking an antiplatelet in the form of clopidogrel. Has recently been diagnosed with atrial fibrillation and warfarin has been initiated. Is there evidence/guideline to suggest whether he should continue clopidogrel for its antiplatelet effect, or should this be discontinued once warfarin treatment is established? I note a previous Attract answer to a similar query in 2009 - any more recent guidance? (2012) [ATTRACT]NEW

Would the levonorgestrel releasing intrauterine system be a suitable method for a woman who has had surgery for removal of four atrial myxomas, has atrial fibrillation and is taking aspirin and if so does she require antibiotic prophylaxis? (2011) )[FSRH]

What is the incidence of Atrial fibrillation (AF) in children under 15. Can AF be familial? (2009)[ATTRACT]

What is the evidence for an alternative anticoagulation e.g. dipyridamole in a patient with AF, who is allergic to aspirin and that warfarin is contra-indicated? (2008) [TRIP Answers]

Is there any evidence or guidance available on the most appropriate way to initiate Warfarin in patients newly diagnosed with chronic AF in the community? (2008)[ATTRACT]



Patient Information

Atrial Fibrillation (2013) [NHS Choices] updated

Atrial Fibrillation (2012) [Patient UK] updated

Atrial fibrillation (2012) [BUPA] NEW



Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.

2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.