Antithrombotic therapy in atrial fibrillation associated with valvular heart disease: a joint consensus document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology Working Group on Thrombosis, endorsed by the ESC Working Group on Valvular Heart Disease, Cardiac Arrhythmia Society of Southern Africa (CASSA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE).
Identifieur interne : 001177 ( Main/Exploration ); précédent : 001176; suivant : 001178Antithrombotic therapy in atrial fibrillation associated with valvular heart disease: a joint consensus document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology Working Group on Thrombosis, endorsed by the ESC Working Group on Valvular Heart Disease, Cardiac Arrhythmia Society of Southern Africa (CASSA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE).
Auteurs : Gregory Y H. Lip [Danemark] ; Jean Philippe Collet [France] ; Raffaele De Caterina [Italie] ; Laurent Fauchier [France] ; Deirdre A. Lane [Danemark] ; Torben B. Larsen [Danemark] ; Francisco Marin [Espagne] ; Joao Morais [Portugal] ; Calambur Narasimhan [Inde] ; Brian Olshansky [États-Unis] ; Luc Pierard [Belgique] ; Tatjana Potpara [Serbie] ; Nizal Sarrafzadegan [Canada] ; Karen Sliwa [Australie] ; Gonzalo Varela [Uruguay] ; Gemma Vilahur [Espagne] ; Thomas Weiss [Autriche] ; Giuseppe Boriani [Italie] ; Bianca Rocca [Italie]Source :
- Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology [ 1532-2092 ] ; 2017.
Abstract
Atrial fibrillation (AF) is a major worldwide public health problem, and AF in association with valvular heart disease (VHD) is also common. However, management strategies for this group of patients have been less informed by randomized trials, which have largely focused on 'non-valvular AF' patients. Thrombo-embolic risk also varies according to valve lesion and may also be associated with CHA2DS2VASc score risk factor components, rather than only the valve disease being causal. Given marked heterogeneity in the definition of valvular and non-valvular AF and variable management strategies, including non-vitamin K antagonist oral anticoagulants (NOACs) in patients with VHD other than prosthetic heart valves or haemodynamically significant mitral valve disease, there is a need to provide expert recommendations for professionals participating in the care of patients presenting with AF and associated VHD. To address this topic, a Task Force was convened by the European Heart Rhythm Association (EHRA) and European Society of Cardiology (ESC) Working Group on Thrombosis, with representation from the ESC Working Group on Valvular Heart Disease, Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE) with the remit to comprehensively review the published evidence, and to publish a joint consensus document on the management of patients with AF and associated VHD, with up-to-date consensus recommendations for clinical practice for different forms of VHD. This consensus document proposes that the term 'valvular AF' is outdated and given that any definition ultimately relates to the evaluated practical use of oral anticoagulation (OAC) type, we propose a functional Evaluated Heartvalves, Rheumatic or Artificial (EHRA) categorization in relation to the type of OAC use in patients with AF, as follows: (i) EHRA Type 1 VHD, which refers to AF patients with 'VHD needing therapy with a Vitamin K antagonist (VKA); and (ii) EHRA Type 2 VHD, which refers to AF patients with 'VHD needing therapy with a VKA or a Non-VKA oral anticoagulant (NOAC)', also taking into consideration CHA2DS2VASc score risk factor components. This consensus document also summarizes current developments in the field, and provides general recommendations for the management of these patients based on the principles of evidence-based medicine.
DOI: 10.1093/europace/eux240
PubMed: 29096024
Affiliations:
- Australie, Autriche, Belgique, Canada, Danemark, Espagne, France, Inde, Italie, Portugal, Serbie, Uruguay, États-Unis
- Angleterre, Catalogne, Centre-Val de Loire, Iowa, Jutland du Nord, Latium, Midlands de l'Ouest, Région Centre, Victoria (État), Vienne (Autriche), Île-de-France
- Aalborg, Barcelone, Birmingham, Melbourne, Paris, Rome, Tours, Vienne (Autriche)
- Université d'Aalborg, Université de Birmingham
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Lane</name><affiliation wicri:level="4"><nlm:affiliation>Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.</nlm:affiliation><country xml:lang="fr">Danemark</country><wicri:regionArea>Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg</wicri:regionArea><orgName type="university">Université de Birmingham</orgName><placeName><settlement type="city">Birmingham</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Midlands de l'Ouest</region></placeName></affiliation></author><author><name sortKey="Larsen, Torben B" sort="Larsen, Torben B" uniqKey="Larsen T" first="Torben B" last="Larsen">Torben B. Larsen</name><affiliation wicri:level="1"><nlm:affiliation>Thrombosis Research Unit,Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.</nlm:affiliation><country xml:lang="fr">Danemark</country><wicri:regionArea>Thrombosis Research Unit,Department of Clinical Medicine, Aalborg University Hospital, Aalborg</wicri:regionArea><wicri:noRegion>Aalborg</wicri:noRegion></affiliation></author><author><name sortKey="Marin, Francisco" sort="Marin, Francisco" uniqKey="Marin F" first="Francisco" last="Marin">Francisco Marin</name><affiliation wicri:level="1"><nlm:affiliation>Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Hospital Universitario Virgen de la Arrixaca, Murcia</wicri:regionArea><wicri:noRegion>Murcia</wicri:noRegion></affiliation></author><author><name sortKey="Morais, Joao" sort="Morais, Joao" uniqKey="Morais J" first="Joao" last="Morais">Joao Morais</name><affiliation wicri:level="1"><nlm:affiliation>Department of Cardiology, Leiria Hospital Centre, Leiria, Portugal.</nlm:affiliation><country xml:lang="fr">Portugal</country><wicri:regionArea>Department of Cardiology, Leiria Hospital Centre, Leiria</wicri:regionArea><wicri:noRegion>Leiria</wicri:noRegion></affiliation></author><author><name sortKey="Narasimhan, Calambur" sort="Narasimhan, Calambur" uniqKey="Narasimhan C" first="Calambur" last="Narasimhan">Calambur Narasimhan</name><affiliation wicri:level="1"><nlm:affiliation>Department of Cardiac Electrophysiology, Care Hospital, Hyderabad, India.</nlm:affiliation><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Cardiac Electrophysiology, Care Hospital, Hyderabad</wicri:regionArea><wicri:noRegion>Hyderabad</wicri:noRegion></affiliation></author><author><name sortKey="Olshansky, Brian" sort="Olshansky, Brian" uniqKey="Olshansky B" first="Brian" last="Olshansky">Brian Olshansky</name><affiliation wicri:level="2"><nlm:affiliation>Mercy Hospital, Mason City, Iowa, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Mercy Hospital, Mason City, Iowa</wicri:regionArea><placeName><region type="state">Iowa</region></placeName></affiliation></author><author><name sortKey="Pierard, Luc" sort="Pierard, Luc" uniqKey="Pierard L" first="Luc" last="Pierard">Luc Pierard</name><affiliation wicri:level="1"><nlm:affiliation>Department of Cardiology, University Hospital Sart-Tilman, Liege, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Cardiology, University Hospital Sart-Tilman, Liege</wicri:regionArea><wicri:noRegion>Liege</wicri:noRegion></affiliation></author><author><name sortKey="Potpara, Tatjana" sort="Potpara, Tatjana" uniqKey="Potpara T" first="Tatjana" last="Potpara">Tatjana Potpara</name><affiliation wicri:level="1"><nlm:affiliation>School of Medicine, Belgrade University; Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia.</nlm:affiliation><country xml:lang="fr">Serbie</country><wicri:regionArea>School of Medicine, Belgrade University; Cardiology Clinic, Clinical Center of Serbia, Belgrade</wicri:regionArea><wicri:noRegion>Belgrade</wicri:noRegion></affiliation></author><author><name sortKey="Sarrafzadegan, Nizal" sort="Sarrafzadegan, Nizal" uniqKey="Sarrafzadegan N" first="Nizal" last="Sarrafzadegan">Nizal Sarrafzadegan</name><affiliation wicri:level="1"><nlm:affiliation>Isfahan Cardiovascular Research Center (WHO Collaborating Center), Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran and School of Population and Public Health, University of British Columbia, Vancouver, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Isfahan Cardiovascular Research Center (WHO Collaborating Center), Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran and School of Population and Public Health, University of British Columbia, Vancouver</wicri:regionArea><wicri:noRegion>Vancouver</wicri:noRegion></affiliation></author><author><name sortKey="Sliwa, Karen" sort="Sliwa, Karen" uniqKey="Sliwa K" first="Karen" last="Sliwa">Karen Sliwa</name><affiliation wicri:level="3"><nlm:affiliation>Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, South Africa; and Mary McKillop Institute, ACU, Melbourne, Australia.</nlm:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, South Africa; and Mary McKillop Institute, ACU, Melbourne</wicri:regionArea><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region></placeName></affiliation></author><author><name sortKey="Varela, Gonzalo" sort="Varela, Gonzalo" uniqKey="Varela G" first="Gonzalo" last="Varela">Gonzalo Varela</name><affiliation wicri:level="1"><nlm:affiliation>Servicio de Electrofisiología, Centro Cardiovascular Casa de Galicia, Hidalgos, Uruguay.</nlm:affiliation><country xml:lang="fr">Uruguay</country><wicri:regionArea>Servicio de Electrofisiología, Centro Cardiovascular Casa de Galicia, Hidalgos</wicri:regionArea><wicri:noRegion>Hidalgos</wicri:noRegion></affiliation></author><author><name sortKey="Vilahur, Gemma" sort="Vilahur, Gemma" uniqKey="Vilahur G" first="Gemma" last="Vilahur">Gemma Vilahur</name><affiliation wicri:level="3"><nlm:affiliation>Cardiovascular Science Institute - ICCC, IIB-Sant Pau, CiberCV, Hospital de Sant Pau, Barcelona, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Cardiovascular Science Institute - ICCC, IIB-Sant Pau, CiberCV, Hospital de Sant Pau, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Weiss, Thomas" sort="Weiss, Thomas" uniqKey="Weiss T" first="Thomas" last="Weiss">Thomas Weiss</name><affiliation wicri:level="3"><nlm:affiliation>Medical Department For Cardiology and Intensive Care, Wilhelminenhospital, and Medical Faculty Sigmund Freud University, Vienna, Austria.</nlm:affiliation><country xml:lang="fr">Autriche</country><wicri:regionArea>Medical Department For Cardiology and Intensive Care, Wilhelminenhospital, and Medical Faculty Sigmund Freud University, Vienna</wicri:regionArea><placeName><settlement type="city">Vienne (Autriche)</settlement><region nuts="2" type="province">Vienne (Autriche)</region></placeName></affiliation></author><author><name sortKey="Boriani, Giuseppe" sort="Boriani, Giuseppe" uniqKey="Boriani G" first="Giuseppe" last="Boriani">Giuseppe Boriani</name><affiliation wicri:level="1"><nlm:affiliation>Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Modena</wicri:regionArea><wicri:noRegion>Modena</wicri:noRegion></affiliation></author><author><name sortKey="Rocca, Bianca" sort="Rocca, Bianca" uniqKey="Rocca B" first="Bianca" last="Rocca">Bianca Rocca</name><affiliation wicri:level="3"><nlm:affiliation>Institute of Pharmacology, Catholic University School of Medicine, Rome, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Institute of Pharmacology, Catholic University School of Medicine, Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2017">2017</date><idno type="RBID">pubmed:29096024</idno><idno 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document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology Working Group on Thrombosis, endorsed by the ESC Working Group on Valvular Heart Disease, Cardiac Arrhythmia Society of Southern Africa (CASSA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE).</title><author><name sortKey="Lip, Gregory Y H" sort="Lip, Gregory Y H" uniqKey="Lip G" first="Gregory Y H" last="Lip">Gregory Y H. Lip</name><affiliation wicri:level="4"><nlm:affiliation>Institute of Cardiovascular Sciences, University of Birmingham and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark.</nlm:affiliation><country xml:lang="fr">Danemark</country><wicri:regionArea>Institute of Cardiovascular Sciences, University of Birmingham and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University</wicri:regionArea><placeName><settlement type="city">Aalborg</settlement><region nuts="2" type="region">Jutland du Nord</region></placeName><orgName type="university">Université d'Aalborg</orgName></affiliation></author><author><name sortKey="Collet, Jean Philippe" sort="Collet, Jean Philippe" uniqKey="Collet J" first="Jean Philippe" last="Collet">Jean Philippe Collet</name><affiliation wicri:level="3"><nlm:affiliation>Sorbonne Université Paris 6, ACTION Study Group, Institut De Cardiologie, Groupe Hôpital Pitié-Salpetrière (APHP), INSERM UMRS 1166, Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Sorbonne Université Paris 6, ACTION Study Group, Institut De Cardiologie, Groupe Hôpital Pitié-Salpetrière (APHP), INSERM UMRS 1166, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Caterina, Raffaele De" sort="Caterina, Raffaele De" uniqKey="Caterina R" first="Raffaele De" last="Caterina">Raffaele De Caterina</name><affiliation wicri:level="1"><nlm:affiliation>Institute of Cardiology, 'G. D'Annunzio' University, Chieti, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Institute of Cardiology, 'G. D'Annunzio' University, Chieti</wicri:regionArea><wicri:noRegion>Chieti</wicri:noRegion></affiliation></author><author><name sortKey="Fauchier, Laurent" sort="Fauchier, Laurent" uniqKey="Fauchier L" first="Laurent" last="Fauchier">Laurent Fauchier</name><affiliation wicri:level="3"><nlm:affiliation>Centre Hospitalier Universitaire Trousseau et Faculté de Medicinde, Université François Rabelais, Tours, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Centre Hospitalier Universitaire Trousseau et Faculté de Medicinde, Université François Rabelais, Tours</wicri:regionArea><placeName><region type="region">Centre-Val de Loire</region><region type="old region">Région Centre</region><settlement type="city">Tours</settlement></placeName></affiliation></author><author><name sortKey="Lane, Deirdre A" sort="Lane, Deirdre A" uniqKey="Lane D" first="Deirdre A" last="Lane">Deirdre A. Lane</name><affiliation wicri:level="4"><nlm:affiliation>Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.</nlm:affiliation><country xml:lang="fr">Danemark</country><wicri:regionArea>Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg</wicri:regionArea><orgName type="university">Université de Birmingham</orgName><placeName><settlement type="city">Birmingham</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Midlands de l'Ouest</region></placeName></affiliation></author><author><name sortKey="Larsen, Torben B" sort="Larsen, Torben B" uniqKey="Larsen T" first="Torben B" last="Larsen">Torben B. Larsen</name><affiliation wicri:level="1"><nlm:affiliation>Thrombosis Research Unit,Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.</nlm:affiliation><country xml:lang="fr">Danemark</country><wicri:regionArea>Thrombosis Research Unit,Department of Clinical Medicine, Aalborg University Hospital, Aalborg</wicri:regionArea><wicri:noRegion>Aalborg</wicri:noRegion></affiliation></author><author><name sortKey="Marin, Francisco" sort="Marin, Francisco" uniqKey="Marin F" first="Francisco" last="Marin">Francisco Marin</name><affiliation wicri:level="1"><nlm:affiliation>Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Hospital Universitario Virgen de la Arrixaca, Murcia</wicri:regionArea><wicri:noRegion>Murcia</wicri:noRegion></affiliation></author><author><name sortKey="Morais, Joao" sort="Morais, Joao" uniqKey="Morais J" first="Joao" last="Morais">Joao Morais</name><affiliation wicri:level="1"><nlm:affiliation>Department of Cardiology, Leiria Hospital Centre, Leiria, Portugal.</nlm:affiliation><country xml:lang="fr">Portugal</country><wicri:regionArea>Department of Cardiology, Leiria Hospital Centre, Leiria</wicri:regionArea><wicri:noRegion>Leiria</wicri:noRegion></affiliation></author><author><name sortKey="Narasimhan, Calambur" sort="Narasimhan, Calambur" uniqKey="Narasimhan C" first="Calambur" last="Narasimhan">Calambur Narasimhan</name><affiliation wicri:level="1"><nlm:affiliation>Department of Cardiac Electrophysiology, Care Hospital, Hyderabad, India.</nlm:affiliation><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Cardiac Electrophysiology, Care Hospital, Hyderabad</wicri:regionArea><wicri:noRegion>Hyderabad</wicri:noRegion></affiliation></author><author><name sortKey="Olshansky, Brian" sort="Olshansky, Brian" uniqKey="Olshansky B" first="Brian" last="Olshansky">Brian Olshansky</name><affiliation wicri:level="2"><nlm:affiliation>Mercy Hospital, Mason City, Iowa, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Mercy Hospital, Mason City, Iowa</wicri:regionArea><placeName><region type="state">Iowa</region></placeName></affiliation></author><author><name sortKey="Pierard, Luc" sort="Pierard, Luc" uniqKey="Pierard L" first="Luc" last="Pierard">Luc Pierard</name><affiliation wicri:level="1"><nlm:affiliation>Department of Cardiology, University Hospital Sart-Tilman, Liege, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Cardiology, University Hospital Sart-Tilman, Liege</wicri:regionArea><wicri:noRegion>Liege</wicri:noRegion></affiliation></author><author><name sortKey="Potpara, Tatjana" sort="Potpara, Tatjana" uniqKey="Potpara T" first="Tatjana" last="Potpara">Tatjana Potpara</name><affiliation wicri:level="1"><nlm:affiliation>School of Medicine, Belgrade University; Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia.</nlm:affiliation><country xml:lang="fr">Serbie</country><wicri:regionArea>School of Medicine, Belgrade University; Cardiology Clinic, Clinical Center of Serbia, Belgrade</wicri:regionArea><wicri:noRegion>Belgrade</wicri:noRegion></affiliation></author><author><name sortKey="Sarrafzadegan, Nizal" sort="Sarrafzadegan, Nizal" uniqKey="Sarrafzadegan N" first="Nizal" last="Sarrafzadegan">Nizal Sarrafzadegan</name><affiliation wicri:level="1"><nlm:affiliation>Isfahan Cardiovascular Research Center (WHO Collaborating Center), Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran and School of Population and Public Health, University of British Columbia, Vancouver, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Isfahan Cardiovascular Research Center (WHO Collaborating Center), Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran and School of Population and Public Health, University of British Columbia, Vancouver</wicri:regionArea><wicri:noRegion>Vancouver</wicri:noRegion></affiliation></author><author><name sortKey="Sliwa, Karen" sort="Sliwa, Karen" uniqKey="Sliwa K" first="Karen" last="Sliwa">Karen Sliwa</name><affiliation wicri:level="3"><nlm:affiliation>Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, South Africa; and Mary McKillop Institute, ACU, Melbourne, Australia.</nlm:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, South Africa; and Mary McKillop Institute, ACU, Melbourne</wicri:regionArea><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region></placeName></affiliation></author><author><name sortKey="Varela, Gonzalo" sort="Varela, Gonzalo" uniqKey="Varela G" first="Gonzalo" last="Varela">Gonzalo Varela</name><affiliation wicri:level="1"><nlm:affiliation>Servicio de Electrofisiología, Centro Cardiovascular Casa de Galicia, Hidalgos, Uruguay.</nlm:affiliation><country xml:lang="fr">Uruguay</country><wicri:regionArea>Servicio de Electrofisiología, Centro Cardiovascular Casa de Galicia, Hidalgos</wicri:regionArea><wicri:noRegion>Hidalgos</wicri:noRegion></affiliation></author><author><name sortKey="Vilahur, Gemma" sort="Vilahur, Gemma" uniqKey="Vilahur G" first="Gemma" last="Vilahur">Gemma Vilahur</name><affiliation wicri:level="3"><nlm:affiliation>Cardiovascular Science Institute - ICCC, IIB-Sant Pau, CiberCV, Hospital de Sant Pau, Barcelona, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Cardiovascular Science Institute - ICCC, IIB-Sant Pau, CiberCV, Hospital de Sant Pau, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Weiss, Thomas" sort="Weiss, Thomas" uniqKey="Weiss T" first="Thomas" last="Weiss">Thomas Weiss</name><affiliation wicri:level="3"><nlm:affiliation>Medical Department For Cardiology and Intensive Care, Wilhelminenhospital, and Medical Faculty Sigmund Freud University, Vienna, Austria.</nlm:affiliation><country xml:lang="fr">Autriche</country><wicri:regionArea>Medical Department For Cardiology and Intensive Care, Wilhelminenhospital, and Medical Faculty Sigmund Freud University, Vienna</wicri:regionArea><placeName><settlement type="city">Vienne (Autriche)</settlement><region nuts="2" type="province">Vienne (Autriche)</region></placeName></affiliation></author><author><name sortKey="Boriani, Giuseppe" sort="Boriani, Giuseppe" uniqKey="Boriani G" first="Giuseppe" last="Boriani">Giuseppe Boriani</name><affiliation wicri:level="1"><nlm:affiliation>Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Modena</wicri:regionArea><wicri:noRegion>Modena</wicri:noRegion></affiliation></author><author><name sortKey="Rocca, Bianca" sort="Rocca, Bianca" uniqKey="Rocca B" first="Bianca" last="Rocca">Bianca Rocca</name><affiliation wicri:level="3"><nlm:affiliation>Institute of Pharmacology, Catholic University School of Medicine, Rome, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Institute of Pharmacology, Catholic University School of Medicine, Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author></analytic><series><title level="j">Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology</title><idno type="eISSN">1532-2092</idno><imprint><date when="2017" type="published">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Atrial fibrillation (AF) is a major worldwide public health problem, and AF in association with valvular heart disease (VHD) is also common. However, management strategies for this group of patients have been less informed by randomized trials, which have largely focused on 'non-valvular AF' patients. Thrombo-embolic risk also varies according to valve lesion and may also be associated with CHA2DS2VASc score risk factor components, rather than only the valve disease being causal. Given marked heterogeneity in the definition of valvular and non-valvular AF and variable management strategies, including non-vitamin K antagonist oral anticoagulants (NOACs) in patients with VHD other than prosthetic heart valves or haemodynamically significant mitral valve disease, there is a need to provide expert recommendations for professionals participating in the care of patients presenting with AF and associated VHD. To address this topic, a Task Force was convened by the European Heart Rhythm Association (EHRA) and European Society of Cardiology (ESC) Working Group on Thrombosis, with representation from the ESC Working Group on Valvular Heart Disease, Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE) with the remit to comprehensively review the published evidence, and to publish a joint consensus document on the management of patients with AF and associated VHD, with up-to-date consensus recommendations for clinical practice for different forms of VHD. This consensus document proposes that the term 'valvular AF' is outdated and given that any definition ultimately relates to the evaluated practical use of oral anticoagulation (OAC) type, we propose a functional Evaluated Heartvalves, Rheumatic or Artificial (EHRA) categorization in relation to the type of OAC use in patients with AF, as follows: (i) EHRA Type 1 VHD, which refers to AF patients with 'VHD needing therapy with a Vitamin K antagonist (VKA); and (ii) EHRA Type 2 VHD, which refers to AF patients with 'VHD needing therapy with a VKA or a Non-VKA oral anticoagulant (NOAC)', also taking into consideration CHA2DS2VASc score risk factor components. This consensus document also summarizes current developments in the field, and provides general recommendations for the management of these patients based on the principles of evidence-based medicine.</div></front></TEI><affiliations><list><country><li>Australie</li><li>Autriche</li><li>Belgique</li><li>Canada</li><li>Danemark</li><li>Espagne</li><li>France</li><li>Inde</li><li>Italie</li><li>Portugal</li><li>Serbie</li><li>Uruguay</li><li>États-Unis</li></country><region><li>Angleterre</li><li>Catalogne</li><li>Centre-Val de Loire</li><li>Iowa</li><li>Jutland du Nord</li><li>Latium</li><li>Midlands de l'Ouest</li><li>Région Centre</li><li>Victoria (État)</li><li>Vienne (Autriche)</li><li>Île-de-France</li></region><settlement><li>Aalborg</li><li>Barcelone</li><li>Birmingham</li><li>Melbourne</li><li>Paris</li><li>Rome</li><li>Tours</li><li>Vienne (Autriche)</li></settlement><orgName><li>Université d'Aalborg</li><li>Université de Birmingham</li></orgName></list><tree><country name="Danemark"><region name="Jutland du Nord"><name sortKey="Lip, Gregory Y H" sort="Lip, Gregory Y H" uniqKey="Lip G" first="Gregory Y H" last="Lip">Gregory Y H. Lip</name></region><name sortKey="Lane, Deirdre A" sort="Lane, Deirdre A" uniqKey="Lane D" first="Deirdre A" last="Lane">Deirdre A. Lane</name><name sortKey="Larsen, Torben B" sort="Larsen, Torben B" uniqKey="Larsen T" first="Torben B" last="Larsen">Torben B. Larsen</name></country><country name="France"><region name="Île-de-France"><name sortKey="Collet, Jean Philippe" sort="Collet, Jean Philippe" uniqKey="Collet J" first="Jean Philippe" last="Collet">Jean Philippe Collet</name></region><name sortKey="Fauchier, Laurent" sort="Fauchier, Laurent" uniqKey="Fauchier L" first="Laurent" last="Fauchier">Laurent Fauchier</name></country><country name="Italie"><noRegion><name sortKey="Caterina, Raffaele De" sort="Caterina, Raffaele De" uniqKey="Caterina R" first="Raffaele De" last="Caterina">Raffaele De Caterina</name></noRegion><name sortKey="Boriani, Giuseppe" sort="Boriani, Giuseppe" uniqKey="Boriani G" first="Giuseppe" last="Boriani">Giuseppe Boriani</name><name sortKey="Rocca, Bianca" sort="Rocca, Bianca" uniqKey="Rocca B" first="Bianca" last="Rocca">Bianca Rocca</name></country><country name="Espagne"><noRegion><name sortKey="Marin, Francisco" sort="Marin, Francisco" uniqKey="Marin F" first="Francisco" last="Marin">Francisco Marin</name></noRegion><name sortKey="Vilahur, Gemma" sort="Vilahur, Gemma" uniqKey="Vilahur G" first="Gemma" last="Vilahur">Gemma Vilahur</name></country><country name="Portugal"><noRegion><name sortKey="Morais, Joao" sort="Morais, Joao" uniqKey="Morais J" first="Joao" last="Morais">Joao Morais</name></noRegion></country><country name="Inde"><noRegion><name sortKey="Narasimhan, Calambur" sort="Narasimhan, Calambur" uniqKey="Narasimhan C" first="Calambur" last="Narasimhan">Calambur Narasimhan</name></noRegion></country><country name="États-Unis"><region name="Iowa"><name sortKey="Olshansky, Brian" sort="Olshansky, Brian" uniqKey="Olshansky B" first="Brian" last="Olshansky">Brian Olshansky</name></region></country><country name="Belgique"><noRegion><name sortKey="Pierard, Luc" sort="Pierard, Luc" uniqKey="Pierard L" first="Luc" last="Pierard">Luc Pierard</name></noRegion></country><country name="Serbie"><noRegion><name sortKey="Potpara, Tatjana" sort="Potpara, Tatjana" uniqKey="Potpara T" first="Tatjana" last="Potpara">Tatjana Potpara</name></noRegion></country><country name="Canada"><noRegion><name sortKey="Sarrafzadegan, Nizal" sort="Sarrafzadegan, Nizal" uniqKey="Sarrafzadegan N" first="Nizal" last="Sarrafzadegan">Nizal Sarrafzadegan</name></noRegion></country><country name="Australie"><region name="Victoria (État)"><name sortKey="Sliwa, Karen" sort="Sliwa, Karen" uniqKey="Sliwa K" first="Karen" last="Sliwa">Karen Sliwa</name></region></country><country name="Uruguay"><noRegion><name sortKey="Varela, Gonzalo" sort="Varela, Gonzalo" uniqKey="Varela G" first="Gonzalo" last="Varela">Gonzalo Varela</name></noRegion></country><country name="Autriche"><region name="Vienne (Autriche)"><name sortKey="Weiss, Thomas" sort="Weiss, Thomas" uniqKey="Weiss T" first="Thomas" last="Weiss">Thomas Weiss</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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|texte= Antithrombotic therapy in atrial fibrillation associated with valvular heart disease: a joint consensus document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology Working Group on Thrombosis, endorsed by the ESC Working Group on Valvular Heart Disease, Cardiac Arrhythmia Society of Southern Africa (CASSA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE).
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