Cengiz BURAK, Erkan BAYSAL, Bernas ALTINTAŞ, İlyas KAYA, Serhat GÜNLÜ, Muhammed SÜLEYMANOĞLU, Serhat HAYME

A Survey Among Invasive Cardiologists to Assess Their Awareness of Atrial Fibrillation

ABSTRACT INTRODUCTION: Atrial fibrillation (AF) may occur in different clinical situations and has various treatment options. Therefore, clinical practice in real-life conditions may also be heterogeneous. The main aim of this survey was to evaluate the treatment approaches taken by invasive cardiologists in response to AF. METHODS: At the 2017 interventional cardiology congress, a survey was conducted in which voluntary participants were randomly assigned, and 134 survey results were evaluated. The survey questionnaire covered topics of i) AF recognition and medical treatment approaches in certain situations, ii) approaches to AF ablation, and iii) the management of anticoagulation and antiplatelet therapy in patients with recent stent implantations. RESULTS: Most participants preferred novel oral anticoagulation in patients with AF and mild mitral stenosis, but one-quarter of the participants preferred using VKA. For AF patients with hypertrophic cardiomyopathy whose CHA2DS2-VASc score was zero, 58.96% of participants preferred acetylsalicylic acid. Regarding their approach to ablation, 73.88% of physicians preferred ablation after third attack in symptomatic AF patients. When it came to the duration of prescribing oral anticoagulants in combination with dual antiplatelet therapy for patients with implanted drugeluting stents due to acute myocardial infarctions, 64.18% of physicians preferred to prescribe triple therapy for three months, followed by 12 months of dual therapy. DISCUSSION and CONCLUSION: The present survey showed differences in the approach to AF and, in some cases, incompatibility with the guidelines. This may be due to insufficient follow-up of the guidelines, or it may be due to a lack of clear recommendations supported by sufficient data on some subjects.

Girişimsel Kardiyologlar Arasında Atriyal Fibrilasyon Farkındalık Anketi Değerlendirmesi

ÖZ GİRİŞ ve AMAÇ: Atriyal fibrilasyon (AF), farklı klinik durumlarda ortaya çıkabilir ve çeşitli tedavi seçeneklerine sahiptir. Bu nedenle, gerçek yaşam koşullarında klinik uygulama da heterojen olabilir. Bu araştırmanın temel amacı, invazif kardiyologların AF’ ye yaklaşımını ve bu konudaki tedavi yaklaşımlarını değerlendirmektir. YÖNTEM ve GEREÇLER: 2017 Girişimsel kardiyoloji kongresinde, katılımcıların rastgele seçildiği ancak katılımın gönüllük esasına dayandığı bir anket çalışması yapılmış ve 134 anket sonucu değerlendirilmiştir. Anket formu, i) AF’yi tanıma ve belirli durumlarda medikal tedavi yaklaşımları, ii) AF ablasyonu yaklaşımları ve iii) stent takılan hastalarda antikoagülasyon ve antiplatelet tedavinin yönetimi konularını içermiştir. BULGULAR: AF ve hafif mitral darlığı olan hastada, katılımcıların çoğu yeni oral antikoagülan kullanımını tercih ederken, katılımcıların dörtte biri vitamin K antagonisti kullanmayı tercih etmiştir. CHA2DS2-VASc skoru 0, hipertrofik kardiyomiyopatisi olan AF hastasında katılımcıların çoğu asetilsalisilik asit kullanmayı tercih etmiş, oral antikoagülan tercih oranı ise %33.58 olmuştur. Semptomatik AF hastalarında hekimlerin %73,88' i üçüncü ataktan sonra ablasyonu tercih etmiş. Akut miyokard enfarktüsü nedeniyle ilaç kaplı stent takılan hastalarda ikili antiplatelet tedavi ile beraber oral antikoagülasyon süresine bakıldığında, çoğunlukla 3 ay üçlü tedavi, 12 aya kadar ikili tedavi seçeneği tercih edilmiştir (%64.18). TARTIŞMA ve SONUÇ: Mevcut araştırma, girişimsel kardiyologlar arasında atriyal fibrilasyona yaklaşım konusunda farklılıklar ve bazı durumlarda kılavuzlarla uyumsuz yaklaşımlar olduğunu göstermiştir. Bu sonuç, kılavuzların yetersiz takibinden veya bazı konularda yeterli veri ile desteklenen net bir tavsiyenin bulunmayışından kaynaklı olabilir.

PDF

___

1. Bjorck S, Palaszewski B, Friberg L, Bergfeldt L. Atrial fibrillation, stroke risk, and warfarin therapy revisited: a population-based study. Stroke. 2013;44(11):3103-8.

2. Haim M, Hoshen M, Reges O, Rabi Y, Balicer R, Leibowitz M. Prospective national study of the prevalence, incidence, management and outcome of a large contemporary cohort of patients with incident non-valvular atrial fibrillation. J Am Heart Assoc. 2015;4(1):e001486.

3. Uyarel H, Onat A, Yüksel H, Can G, Ordu S, Dursunoğlu D. Incidence, prevalence, and mortality estimates for chronic atrial fibrillation in Turkish adults. Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir. 2008;36(4):214-22.

4. Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010;138(5):1093-100.

5. Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2010;137(2):263-72.

6. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893-962.

7. Halperin JL, Hart RG. Atrial fibrillation and stroke: new ideas, persisting dilemmas. Stroke. 1988;19(8):937-41.

8. Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2017;14(10):e275-e444.

9. January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC, Jr., et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014;64(21):e1-76.

10. Mohanty S, Santangeli P, Mohanty P, Di Biase L, Holcomb S, Trivedi C, et al. Catheter ablation of asymptomatic longstanding persistent atrial fibrillation: impact on quality of life, exercise performance, arrhythmia perception, and arrhythmia-free survival. J Cardiovasc Electrophysiol. 2014;25(10):1057-64.

11. Valgimigli M, Patialiakas A, Thury A, McFadden E, Colangelo S, Campo G, et al. Zotarolimus-eluting versus bare-metal stents in uncertain drug-eluting stent candidates. J Am Coll Cardiol. 2015;65(8):805-15.

12. Ariotti S, Adamo M, Costa F, Patialiakas A, Briguori C, Thury A, et al. Is Bare-Metal Stent Implantation Still Justifiable in High Bleeding Risk Patients Undergoing Percutaneous Coronary Intervention?: A Pre-Specified Analysis From the ZEUS Trial. JACC Cardiovasc Interv. 2016;9(5):426-36.

13. Authors/Task Force m, Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014;35(37):2541-619.

14. Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2018;39(3):213-60.

15. Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12):1139-51.

16. Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365(10):883-91.

17. Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365(11):981-92.

18. Giugliano RP, Ruff CT, Braunwald E, Murphy SA, Wiviott SD, Halperin JL, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013;369(22):2093-104.

19. Ertas F, Kaya H, Kaya Z, Bulur S, Kose N, Gul M, et al. Epidemiology of atrial fibrillation in Turkey: preliminary results of the multicenter AFTER study. Turk Kardiyol Dern Ars. 2013;41(2):99-104.

20. Ertas F, Duygu H, Acet H, Eren NK, Nazli C, Ergene AO. [Oral anticoagulant use in patients with atrial fibrillation]. Turk Kardiyol Dern Ars. 2009;37(3):161-7.

21. Alışır Mf, Keçebaş M, Beşli F, Çalışkan S, Güngören F, Yıldırım A, et al. Varfarin kullanan hastalarda etkin INR düzeyi oranları ve etiyoloji ile olan ilişkisi. Turkiye Klinikleri Journal of Medical Sciences. 2013;33(3):868-73.