Abstract
Management strategies for patients with atrial fibrillation (AF) in association with
valvular heart disease (VHD) have been less informed by randomized trials, which have
largely focused on ‘non-valvular AF’ patients. Thromboembolic risk also varies according
to valve lesion and may also be associated with CHA2 DS2 -VASc score risk factor components, rather than only the valve disease being causal.
Given the need to provide expert recommendations for professionals participating in
the care of patients presenting with AF and associated VHD, a task force was convened
by the European Heart Rhythm Association (EHRA) and European Society of Cardiology
(ESC) Working Group (WG) on Thrombosis, with representation from the ESC WG 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 produce a consensus document on the management of patients
with AF and associated VHD, with up-to-date consensus statements for clinical practice
for different forms of VHD, based on the principles of evidence-based medicine.
This is an executive summary of a consensus document which 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‘valvular AF’ is outdated and given that any definition ultimately relates to the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 EHRA (Evaluated Heartvalves, Rheumatic or Artificial) categorization in relation to the type of OAC use in patients with AF, as follows: (1) EHRA (Evaluated Heartvalves, Rheumatic or Artificial) type 1 VHD, which refers to AF patients
with ‘VHD needing therapy with a vitamin K antagonist (VKA)’ and (2) EHRA (Evaluated Heartvalves, Rheumatic or Artificial) type 2 VHD, which refers to AF patients
with ‘VHD needing therapy with a VKA or a non-VKA oral anticoagulant also taking into
consideration CHA2 DS2 -VASc score risk factor components.
Keywords atrial fibrillation - valvular heart disease - mitral stenosis - mechanical prosthetic
heart valves - thromboembolism - stroke - stroke prevention - anticoagulation - vitamin
K antagonists - NOACs
