Guidelines for the management of atrial fibrillation released
Guidelines for the management of atrial fibrillation (AF) have been released by the European Society of Cardiology (ESC).
AF remains one of the major causes of stroke, heart failure, sudden death and cardiovascular morbidity in the world, with emerging evidence offering innovative approaches to its diagnosis and management.
The guidelines list recommendations for diagnosis, general management, stroke prevention, rate control and rhythm control of AF.
Catheter ablation, which has now become a common treatment for recurrent AF, is also discussed as a possible treatment within the guidelines. In general, it should be used as second-line treatment after failure of or intolerance to antiarrhythmic drug therapy. In such patients, when performed in experienced centres by adequately trained teams, catheter ablation is more effective than antiarrhythmic drug therapy.
Other guideline recommendations for the management of AF include:
- Opportunistic screening for AF is recommended by pulse taking or ECG rhythm strip in patients over the age of 65
- The proposal of lifestyle changes to all suitable AF patients to make their management more effective
- The use of the CHA2DS2-VASc score to predict stroke risk, and initiation of oral anticoagulation when score is 2 or more for males, or 2 or more for females
- The avoidance of combinations of oral anticoagulants and platelet inhibitors in AF patients without another indication for platelet inhibition
- The selection of antiarrhythmic drugs based on the presence of co-morbidities, cardiovascular risk, potential for proarrhythmia, extracardiac toxic effects, patient preference and symptoms, and consideration of catheter or surgical ablation when antiarrhythmic drugs fail
- Moderate regular physical activity is recommended to prevent AF, while athletes should be counselled that long-lasting, more intense sports participation can promote AF