TY - JOUR
T1 - Spotlight on the 2024 ESC/EACTS management of atrial fibrillation guidelines
T2 - 10 novel key aspects
AU - Rienstra, Michiel
AU - Tzeis, Stylianos
AU - Bunting, Karina
AU - Caso, Valeria
AU - Crijns, Harry J. G. M.
AU - De Potter, Tom J. R.
AU - Sanders, Prashanthan
AU - Svennberg, Emma
AU - Casado-Arroyo, Ruben
AU - Dwight, Jeremy
AU - Guasti, Luigina
AU - Hanke, Thorsten
AU - Jaarsma, Tiny
AU - Lettino, Maddalena
AU - Lochen, Maja-Lisa
AU - Lumbers, R. Thomas
AU - Maesen, Bart
AU - Molgaard, Inge
AU - Rosano, Giuseppe M. C.
AU - Schnabel, Renate B.
AU - Suwalski, Piotr
AU - Tamargo, Juan
AU - Tica, Otilia
AU - Traykov, Vassil
AU - Kotecha, Dipak
AU - Van Gelder, Isabelle C.
PY - 2024/12/24
Y1 - 2024/12/24
N2 - Atrial fibrillation (AF) remains the most common cardiac arrhythmia worldwide and is associated with significant morbidity and mortality. The European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (EACTS) have recently released the 2024 guidelines for the management of AF. This review highlights 10 novel aspects of the ESC/EACTS 2024 Guidelines. The AF-CARE framework is introduced, a structural approach that aims to improve patient care and outcomes, comprising of four pillars: [C] Comorbidity and risk factor management, [A] Avoid stroke and thromboembolism, [R] Reduce symptoms by rate and rhythm control, and [E] Evaluation and dynamic reassessment. Additionally, graphical patient pathways are provided to enhance clinical application. A significant shift is the new emphasis on comorbidity and risk factor control to reduce AF recurrence and progression. Individualized assessment of risk is suggested to guide the initiation of oral anticoagulation to prevent thromboembolism. New guidance is provided for anticoagulation in patients with trigger-induced and device-detected sub-clinical AF, ischaemic stroke despite anticoagulation, and the indications for percutaneous/surgical left atrial appendage exclusion. AF ablation is a first-line rhythm control option for suitable patients with paroxysmal AF, and in specific patients, rhythm control can improve prognosis. The AF duration threshold for early cardioversion was reduced from 48 to 24 h, and a wait-and-see approach for spontaneous conversion is advised to promote patient safety. Lastly, strong emphasis is given to optimize the implementation of AF guidelines in daily practice using a patient-centred, multidisciplinary and shared-care approach, with the simultaneous launch of a patient version of the guideline.
AB - Atrial fibrillation (AF) remains the most common cardiac arrhythmia worldwide and is associated with significant morbidity and mortality. The European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (EACTS) have recently released the 2024 guidelines for the management of AF. This review highlights 10 novel aspects of the ESC/EACTS 2024 Guidelines. The AF-CARE framework is introduced, a structural approach that aims to improve patient care and outcomes, comprising of four pillars: [C] Comorbidity and risk factor management, [A] Avoid stroke and thromboembolism, [R] Reduce symptoms by rate and rhythm control, and [E] Evaluation and dynamic reassessment. Additionally, graphical patient pathways are provided to enhance clinical application. A significant shift is the new emphasis on comorbidity and risk factor control to reduce AF recurrence and progression. Individualized assessment of risk is suggested to guide the initiation of oral anticoagulation to prevent thromboembolism. New guidance is provided for anticoagulation in patients with trigger-induced and device-detected sub-clinical AF, ischaemic stroke despite anticoagulation, and the indications for percutaneous/surgical left atrial appendage exclusion. AF ablation is a first-line rhythm control option for suitable patients with paroxysmal AF, and in specific patients, rhythm control can improve prognosis. The AF duration threshold for early cardioversion was reduced from 48 to 24 h, and a wait-and-see approach for spontaneous conversion is advised to promote patient safety. Lastly, strong emphasis is given to optimize the implementation of AF guidelines in daily practice using a patient-centred, multidisciplinary and shared-care approach, with the simultaneous launch of a patient version of the guideline.
KW - Atrial fibrillation
KW - Management
KW - Guidelines
KW - RADIOFREQUENCY CATHETER ABLATION
KW - ANTAGONIST ORAL ANTICOAGULANTS
KW - ANTIARRHYTHMIC-DRUG THERAPY
KW - POSITIVE AIRWAY PRESSURE
KW - CHRONIC HEART-FAILURE
KW - RISK-FACTOR
KW - SYSTOLIC DYSFUNCTION
KW - 1ST-LINE TREATMENT
KW - ADVERSE OUTCOMES
KW - EUROPEAN-SOCIETY
U2 - 10.1093/europace/euae298
DO - 10.1093/europace/euae298
M3 - (Systematic) Review article
SN - 1099-5129
VL - 26
JO - EP Europace
JF - EP Europace
IS - 12
M1 - euae298
ER -