Update on the Management of Atrial Fibrillation: Anticoagulation and Medical Therapy Authors
First Online: 09 July 2011 DOI:
Cite this article as: Lim, S.H., Calkins, H. & Sinha, S.K. Curr Cardiol Rep (2011) 13: 387. doi:10.1007/s11886-011-0199-9 Abstract
2010 saw the introduction of dabigatran (Pradaxa; Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT), following US Food and Drug Administration approval, into daily clinical practice in the United States as an alternative to Coumadin (Bristol-Myers-Squibb, New York, NY) therapy. Dronedarone (Multaq; Sanofi-Aventis, Bridgewater, NJ), originally approved for use in the United States in 2009, has seen further widespread deployment in contemporary clinical practice. Intravenous vernakalant (Cardiome Pharm, Vancouver, B.C., Canada; Merck & Co., Whitehouse Station, NJ) is being considered for approval in the United States and may serve as an alternative to current agents for safe and efficacious acute conversion from atrial fibrillation. We focus primarily on new information concerning these and other antiarrhythmic drug and anticoagulation therapies. We provide brief updates of recently published articles along with our perspective on how they will likely alter clinical practice now and in the future.
Keywords Atrial fibrillation Dabigatran Dronedarone Vernakalant Anticoagulation Medical therapy Clinical Trial Acronyms ACT
Atrial Arrhythmia Conversion Trial
Atrial Fibrillation and Congestive Heart Failure
Atrial Fibrillation Follow-up Investigation of Rhythm Management
Antiarrhythmic Trial with Dronedarone in Moderate to Severe CHF Evaluating Morbidity Decrease
Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation
A Trial with Dronedarone to Prevent Hospitalization or Death in Patients with Atrial Fibrillation
Apixaban Versus Acetylsalicylic Acid to Prevent Strokes
A Phase III Superiority Study of Vernakalant Versus Amiodarone in Subjects with Recent Onset Atrial Fibrillation
Efficacy and Safety of Dronedarone Versus Amiodarone for the Maintenance of Sinus Rhythm in Patients with Persistent Atrial Fibrillation
ENGAGE AF-TIMI 48
Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation
Rate Control Versus Electrical Cardioversion for Persistent Atrial Fibrillation
Rate Control Efficacy in Permanent Atrial Fibrillation
Randomized Evaluation of Long-Term Anticoagulation Therapy
Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation
Valsartan in Acute Myocardial Infarction Trial
References Papers of particular interest, published recently, have been highlighted as: • Of importance
Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation-executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation). Eur Heart J. 2006;27:1979–2030.
Lip GY. Does atrial fibrillation confer a hypercoagulable state? Lancet. 1995;346:1313–4.
Chung NA, Belgore F, Li-Saw-Hee FL, et al. Is the hypercoagulable state in atrial fibrillation mediated by vascular endothelial growth factor? Stroke. 2002;33:2187–91.
Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials. Arch Intern Med. 1994;154:1449–57.
Ogilvie IM, Newton N, Welner SA, et al. Underuse of oral anticoagulants in atrial fibrillation: a systematic review. Am J Med. 2010;123:638–45, e4.
Verheugt FWA. Novel oral anticoagulants to prevent stroke in atrial fibrillation. Nat Rev Cardiol. 2010;7:149–54.
Camm AJ, Kirchhof P, Lip GY, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Europace. 2010;12:1360–420.
Wann LS, Curtis AB, January CT, Ellenbogen KA, Lowe JE, Estes III NAM, et al. ACCF/AHA/HRS Focused Update on the Management of Patients With Atrial Fibrillation (Updating the 2006 Guidelines): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Heart Rhythm. 2011;8(1):157–76.
Matchar DB, Jacobson A, Dolor R, et al. Effect of home testing of international normalized ratio on clinical events. N Engl J Med. 2010;363:1608–20.
Pradaxa summary of product characteristics. Ingelheim am Rhein, Germany: Boehringer Ingelheim International; March 2009.
(accessed 2010 Feb 9).
• Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;360:1139–51.
The RE-LY trial included more than 18 000 patients and demonstrated superiority of dabigatran at 150 mg twice daily compared with Coumadin therapy in reducing cardioembolic risk while attenuating the risk of major bleeding.
Nagarakanti R, Ezekowitz MD, Oldgren J, et al. Dabigatran versus warfarin in patients with atrial fibrillation: an analysis of patients undergoing cardioversion. Circulation. 2011;123:131–6.
Gensch C, Hoppe U, Bohm M, et al. Late-breaking clinical trials presented at the American Heart Associaion Congress in Chicago 2010. Clin Res Cardiol. 2011;100:1–9.
Connolly SJ, Eikelboom J, Joyner C, et al. Apixaban in patients with atrial fibrillation. N Engl J Med. 2011. [Epub ahead of print].
Nilsson KR, Al-Khatib SM, Zhou Y, et al. Atrial fibrillation management strategies and early mortality after myocardial infarction: results from the Valsartan in Acute Myocardial Infarction (VALIANT) trial. Heart. 2010;96:838–42.
Van Gelder IC, Groenvelf HF, Crijins HJ, et al. Lenient versus strict rate control in patients with atrial fibrillation. New Engl J Med. 2010;362:1363–7.
Cheng JWM. New and emerging antiarrhythmic and anticoagulant agents for atrial fibrillation. Am J Heath-Syst Pharm. 2010;67:S26–34.
Dobrev D, Nattel S. New antiarrhythmic drugs for treatment of atrial fibrillation. Lancet. 2010;375:1212–23.
Shirolkar SC, Fiuzat M, Becker RC. Dronedarone and vitamin K antagonists: a review of drug-drugs interactions. Am Heart J. 2010;160:577–82.
FDA Drugs Safety Communication: Sever liver injury associated with the use of dronedarone[online]. Available from URL:
[Accessed 2011 Feb 13].
Burashnikov A, Sicouri S, Di Diego JM, et al. Synergistic effect of the combination of ranolazine and dronedarone to suppress atrial fibrillation. J Am Coll Cardiol. 2010;56:1216–24.
Stiell IG, Roos JS, Kavanagh KM, et al. A multicenter, open-label study of vernakalant for the conversion of atrial fibrillation to sinus rhythm. Am Heart J. 2010;159:1095–101.
Duggan ST, Scott LJ. Intravenous vernakalant. A review of its use in the management of recent onset atrial fibrillation. Drugs. 2011;71:237–52.
Cardiome Pharma Corp. Cardiome announces suspension of enrollment in ACT 5 trial [online].Available from URL:
[Accessed 2011 Feb 13].
Camm AJ, Capucci A, Hohnloser SH, et al. A randomized active-controlled study comparing the efficacy and safety of vernakalant to amiodarone in recent-onset atrial fibrillation. J Am Coll Cardiol. 2011;57(3):313–21.
PubMed CrossRef Copyright information
© Springer Science+Business Media, LLC 2011