{"markup":"\u003C?xml version=\u00221.0\u0022 encoding=\u0022UTF-8\u0022 ?\u003E\n    \u003Chtml version=\u0022HTML+RDFa+MathML 1.1\u0022\n    xmlns:content=\u0022http:\/\/purl.org\/rss\/1.0\/modules\/content\/\u0022\n    xmlns:dc=\u0022http:\/\/purl.org\/dc\/terms\/\u0022\n    xmlns:foaf=\u0022http:\/\/xmlns.com\/foaf\/0.1\/\u0022\n    xmlns:og=\u0022http:\/\/ogp.me\/ns#\u0022\n    xmlns:rdfs=\u0022http:\/\/www.w3.org\/2000\/01\/rdf-schema#\u0022\n    xmlns:sioc=\u0022http:\/\/rdfs.org\/sioc\/ns#\u0022\n    xmlns:sioct=\u0022http:\/\/rdfs.org\/sioc\/types#\u0022\n    xmlns:skos=\u0022http:\/\/www.w3.org\/2004\/02\/skos\/core#\u0022\n    xmlns:xsd=\u0022http:\/\/www.w3.org\/2001\/XMLSchema#\u0022\n    xmlns:mml=\u0022http:\/\/www.w3.org\/1998\/Math\/MathML\u0022\u003E\n  \u003Chead\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_itu2PgFdrjV-docKmLK8Jn5oXe_05RgvQh73eOhI_mE.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_at_symbol.js?nzmoq1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_article_reference_popup.js?nzmoq1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_I8yX6RYPZb7AtMcDUA3QKDZqVkvEn35ED11_1i7vVpc.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\n(function(i,s,o,g,r,a,m){i[\u0022GoogleAnalyticsObject\u0022]=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)})(window,document,\u0022script\u0022,\u0022\/\/www.google-analytics.com\/analytics.js\u0022,\u0022ga\u0022);ga(\u0022create\u0022, \u0022UA-15605596-27\u0022, {\u0022cookieDomain\u0022:\u0022auto\u0022});ga(\u0022set\u0022, \u0022page\u0022, location.pathname + location.search + location.hash);ga(\u0022send\u0022, \u0022pageview\u0022);ga(\u0027create\u0027, \u0027UA-189672-26\u0027, \u0027auto\u0027, {\u0027name\u0027: \u0027hwTracker\u0027});\r\nga(\u0027hwTracker.send\u0027, \u0027pageview\u0027);\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\njQuery.extend(Drupal.settings, {\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;10\\\/8\\\/6\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;10\\\/8\\\/6\u0022}],\u0022ac\u0022:{\u0022spmdc;10\\\/8\\\/6\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;10\\\/8\\\/6\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EEach year, during its annual congress, the ESC introduces new and\/or updated Clinical Practice Guidelines that represent the most current evidence-based medicine. The following are selected recommendations from four Practice Guidelines that were presented this year including: updates to the 2008 ESC guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure and the 2007 ESC guidelines for Cardiac and Resynchronization Therapy. Two expanded Class Ia recommendations were also released.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECoronary Artery Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHeart Failure\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Guidelines\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EEach year, during its annual congress, the ESC introduces new and\/or updated Clinical Practice Guidelines that represent the most current evidence-based medicine. The following are selected recommendations from four Practice Guidelines that were presented this year.\u003C\/p\u003E\u003Cp\u003EKenneth Dickstein, MD, University of Bergen, Stavanger, Norway, presented updates to the 2008 ESC guidelines for the \u003Cem\u003EDiagnosis and Treatment of Acute and Chronic Heart Failure\u003C\/em\u003E and the 2007 ESC guidelines for \u003Cem\u003ECardiac and Resynchronization Therapy\u003C\/em\u003E (CRT), which were developed in collaboration with the Heart Failure Association and the European Heart Rhythm Association (EHRA). Two expanded Class Ia recommendations were released:\n\u003C\/p\u003E\u003Col class=\u0022list-ord \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n               \u003Cp id=\u0022p-4\u0022\u003ECRT-P\/CRT-D is recommended to reduce morbidity and mortality in NYHA class III\/IV patients with LVEF of \u226435% and QRS width of \u2265120 ms with a conventional indication for an ICD. This recommendation is supported by the COMPANION [Bristow MR et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2004] and CARE-HF [Cleland JG et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2005] trials. Similar levels of evidence support CRT-P.\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n               \u003Cp id=\u0022p-5\u0022\u003ECRT, preferentially by CRT-D, is recommended to reduce morbidity or to prevent disease progression in NYHA class II patients, LVEF\u226435%, QRS\u2265150 ms, and SR optimal medical therapy. The recommendations are supported by data from the MADIT-CRT [Moss AJ et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2009] and REVERSE trials [Linde C et al. \u003Cem\u003EJ Am Coll Cardiol 2008;\u003C\/em\u003E Daubert C et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2009].\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ol\u003E\u003Cp\u003E\n      \u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003ERisk assessment and an appropriate choice of therapy are central to good clinical practice. The updated Joint \u003Cem\u003EESC-EACTS Guidelines on Myocardial Revascularization,\u003C\/em\u003E presented by Phillippe Kolh, MD, PhD, University Hospital of Li\u00e8ge, Li\u00e8ge, Belgium, and William Wijns, MD, FESC, Co-Director, Cardiovascular Centre, O.L.V.Z., Aalst, Belgium, include new guidance in both areas.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EPatients who take an active role throughout the decision-making process have better outcomes. However, most patients who undergo CABG or PCI have limited understanding of their disease and its treatment. The new Guidelines recommend that patients be adequately informed about the potential benefits and short- and long-term risks of a revascularization procedure. Sufficient time for informed decision-making should be allowed. A sample patient information document is available in the Appendix in the online version of the Guidelines.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003ETo facilitate an appropriate choice of therapy and help ensure the best patient outcome, the new Guidelines recommend multidisciplinary decision-making by a consolidated Heart Team in each institution. Collaboration and discussion between the clinical noninterventional cardiologist, the interventional cardiologist, and the cardiac surgeon are strongly recommended, as is the inclusion of other medical specialists (ie, nephrologists, diabetologists, neurologists, geriatricians), when treating patients with complex CAD and\/or multiple associated comorbidities. The presenters emphasized the guideline recommendation that Heart Team members come to a patient strategy consensus \u003Cspan class=\u0022underline\u0022\u003Eprior\u003C\/span\u003E to revascularization to maximize outcomes.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EPCI presents an ideal example of the need for Heart Team\/institutional agreement of strategic criteria. Ad hoc PCI (an interventional procedure that is performed while the patient is still on the catheterization table) may be well suited for some, but not all, patients. Although it can be cost-effective and associated with fewer access site complications, it is not appropriate for all patients and should not automatically be used as a default approach. Heart Teams and their institutions may want to consider PCI in a different session for patients with special considerations (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11539\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11539\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11539\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-10\u0022 class=\u0022first-child\u0022\u003EPotential Indications for \u003Cem\u003Ead hoc\u003C\/em\u003E PCI Versus Revascularization at an Interval.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-11\u0022\u003EThe Guidelines also include recommendations on risk stratification scores to be used in candidates for PCI or CABG (\u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E):\u003C\/p\u003E\u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11545\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11545\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11545\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-12\u0022 class=\u0022first-child\u0022\u003ERecommended Risk Stratification Scores in Candidates for PCI or CABG.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022list-unord \u0022 id=\u0022list-2\u0022\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n            \u003Cp id=\u0022p-13\u0022\u003EFor PCI, the SYNTAX score is preferred to quantify the complexity of CAD\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\n            \u003Cp id=\u0022p-14\u0022\u003EFor CABG, both the EuroSCORE and STS score are well validated and predominantly based on clinical variables; however, the STS score undergoes periodic adjustments, which makes longitudinal comparisons difficult\u003C\/p\u003E\n         \u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-15\u0022\u003ENew guidelines were issued concerning the indications for revascularization in stable angina or silent ischemia. The two issues that are addressed are: 1) the appropriateness of revascularization and 2) the relative merits of CABG and PCI in differing patterns of CAD. Current best evidence shows that revascularization can be readily justified:\u003C\/p\u003E\u003Cul class=\u0022list-unord \u0022 id=\u0022list-3\u0022\u003E\u003Cli id=\u0022list-item-5\u0022\u003E\n            \u003Cp id=\u0022p-16\u0022\u003EOn symptomatic grounds in patients with persistent limiting symptoms (angina or angina equivalent) despite optimal medical therapy, and\/or\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-6\u0022\u003E\n            \u003Cp id=\u0022p-17\u0022\u003EOn prognostic grounds in certain anatomical patterns of disease AND a proven significant ischemic territory (even in asymptomatic patients). Significant left main stenosis and significant proximal left anterior descending disease, especially in the presence of multivessel CAD, are strong indications for revascularization. In the most severe patterns of CAD, CABG appears to offer a survival advantage as well as a marked reduction in the need for repeat revascularization, albeit at a higher risk of CVA, especially in left main disease.\u003C\/p\u003E\n         \u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-18\u0022\u003EUnlike many of the Guidelines, for which the majority of the recommendations is based on level A or B evidence, those for \u003Cem\u003EGrown-up Congenital Heart Disease\u003C\/em\u003E (GUCH) rely mainly on Level C and some Level B evidence, due to the limited number of randomized clinical trials and the very few large nonrandomized trials in this relatively young specialty. Helmut Baumgartner, MD, University Hospital Muenster, Muenster, Germany, presented the new Guidelines.\u003C\/p\u003E\u003Cp id=\u0022p-19\u0022\u003EImportant changes include more precise definitions and guidance concerning:\u003C\/p\u003E\u003Col class=\u0022list-ord \u0022 id=\u0022list-4\u0022\u003E\u003Cli id=\u0022list-item-7\u0022\u003E\n            \u003Cp id=\u0022p-20\u0022\u003EIndications for cardiac magnetic resonance (CMR) and cardiac catherization; eg, CMR as an alternative to echo when both techniques can provide similar information but when echo can not be obtained with sufficient quality, and specific recommendations for indications where CMR is superior to echo and should be regularly used when the information is essential for patient management. Cardiac catheterization is now reserved for resolution of specific anatomical and physiological questions or for intervention.\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-8\u0022\u003E\n            \u003Cp id=\u0022p-21\u0022\u003ESignificant changes to the recommendations for prevention of infective endocarditis (IE); eg, antibiotic prophylaxis is currently only recommended for patients with the highest risk of IE who are undergoing the highest risk procedures (only for dental procedures that require manipulation of the gingival or periapical region of the teeth or perforation of the the oral mucosa).\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-9\u0022\u003E\n            \u003Cp id=\u0022p-22\u0022\u003ERecommendations for targeted PAH therapy.\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-10\u0022\u003E\n            \u003Cp id=\u0022p-23\u0022\u003EAcknowledgment and guidance on the increasing role of catheter intervention; eg, device closure in atrial and ventricular septal defects and patent ductus arteriosus; stenting in coarctation of the aorta; percutaneous pulmonary valve replacement in tetralogy of Fallot.\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-11\u0022\u003E\n            \u003Cp id=\u0022p-24\u0022\u003EIndications for valve-sparing aortic root replacement at a lower level of aortic dimensions (45 mm to 50 mm) instead of Bentall at 50 mm to 55 mm.\u003C\/p\u003E\n         \u003C\/li\u003E\u003C\/ol\u003E\u003Cp id=\u0022p-25\u0022\u003EA. John Camm, MD, St. George\u0027s University, London, United Kingdom, discussed the first independent ESC \u003Cem\u003EGuidelines for the Management of Atrial Fibrillation (AF).\u003C\/em\u003E Prof. Camm focused on several of the new introductions in the Guidelines, beginning with a repositioning of the classification of AF. Four types are now recognized, including long-standing, persistent AF, defined as AF that has lasted for \u22651 year, and clarification for paroxysmal AF, which is generally self-terminating, usually within 48 hours (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). It is also recommended that patients with AF be classified based on their EHRA score (\u003Ca id=\u0022xref-table-wrap-3-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T3\u0022\u003ETable 3\u003C\/a\u003E; Class 1: Level B).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/8\/6\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Classification of AF.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1461522766\u0022 data-figure-caption=\u0022Classification of AF.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/8\/6\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/8\/6\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/8\/6\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11535\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-26\u0022 class=\u0022first-child\u0022\u003EClassification of AF.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003EReproduced with permission the European Society of Cardiology.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv id=\u0022T3\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11549\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11549\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11549\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 3.\u003C\/span\u003E \n            \u003Cp id=\u0022p-27\u0022 class=\u0022first-child\u0022\u003ESymptom Score.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-28\u0022\u003EThe 2010 Guidelines introduce a new scoring system for thromboembolic risk\u2014the CHA\u003Csub\u003E2\u003C\/sub\u003EDS\u003Csub\u003E2\u003C\/sub\u003E-VASc Score\u2014which includes three new risk factors: vascular disease, age 65 to 74 years, and female gender [Lip GY et al. \u003Cem\u003EChest\u003C\/em\u003E 2010] and has a point score of 2 for age \u226575 years (vs 1 in the CHADs Score). The maximum score is 9.\u003C\/p\u003E\u003Cp\u003EOf the numerous recommendations concerning oral anticoagulation therapy (OAC), Prof. Camm focused on two:\n\u003C\/p\u003E\u003Col class=\u0022list-ord \u0022 id=\u0022list-5\u0022\u003E\u003Cli id=\u0022list-item-12\u0022\u003E\n               \u003Cp id=\u0022p-30\u0022\u003EAntithrombotic therapy to prevent thromboembolism is recommended for all patients with AF, except in those with lone AF, who are aged \u0026lt;65 years, or have contraindications (Class 1: Level A).\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-13\u0022\u003E\n               \u003Cp id=\u0022p-31\u0022\u003ECombination therapy with aspirin 75\u2013100 mg plus clopidogrel 75 mg daily should be considered for stroke prevention in patients who refuse OAC therapy or when there is a clear contraindication to OAC therapy and a low risk of bleeding (Class 11a: Level B).\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ol\u003E\u003Cp\u003E\n      \u003C\/p\u003E\u003Cp id=\u0022p-32\u0022\u003EThe Guidelines now recommend the use of the HAS-BLED Score [Pisters R et al. \u003Cem\u003EChest\u003C\/em\u003E 2010] to determine bleeding risk.\u003C\/p\u003E\u003Cp id=\u0022p-33\u0022\u003EAs in previous guidelines, the primary management for patients with AF is rate control using a lenient strategy for patients who remain asymptomatic and a more strict approach for symptomatic patients (Both Class IIa: Level B).\u003C\/p\u003E\u003Cp id=\u0022p-34\u0022\u003EThe following antiarrhythmic drugs are recommended for rhythm control in patients with AF, depending on underlying heart disease: amiodarone, dronedarone, flecainide, propafenone, d, I-sotalol (all Class 1: Level A).\u003C\/p\u003E\u003Cp id=\u0022p-35\u0022\u003EAll of the guidelines that are mentioned above are available on the ESC website, \u003Ca href=\u0022http:\/\/www.escardio.org\/guidelines\u0022\u003Ehttp:\/\/www.escardio.org\/guidelines\u003C\/a\u003E, and were also published online in the \u003Cem\u003EEur Heart J\u003C\/em\u003E August 29, 2010.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2010 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/10\/8\/6.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmoq1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmoq1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzmoq1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}