Update on atrial fibrillation therapy – new clinical studies (ACTIVE-A, ATHENA)

Atrial fibrillation (AF) is one of the most frequent supraventricular arrhythmias in clinical practice and accounts for one third of hospitalizations due to rhythm disturbance. AF is associated with high risk of thromboembolism, heart failure and death. It is believed that in patients with AF the risk of stroke is 5 times higher than in patients with no accompanying arrhythmia. Oral anticoagulant treatment with vitamin K antagonists decreases the risk of stroke compared to placebo; however, it increases the incidence of bleeding. Treatment with aspirin alone is significantly less efficient in thromboembolism prevention than vitamin K antagonists. Recent clinical trials have shown the benefits of combined treatment with aspirin and clopidogrel in acute coronary syndromes. Thus, the ACTIVE-A study, described in the following article, was designed in order to assess whether combined antiplatelet therapy in patients with AF is more effective than aspirin alone in prevention of strokes and vascular events. Further new data concerning the treatment of AF come from the results of the ATHENA study, in which the antiarrhythmic effect of the new drug dronedarone was studied. This drug might find a practical application in the treatment of AF mostly due to its safety profile as it lacks the serious side effects of amiodarone.