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Atrial Fibrillation (Management of) 2016

ESC Clinical Practice Guidelines

Despite good progress in the management of patients with atrial fibrillation (AF), this arrhythmia remains one of the major causes of stroke, hert failure, sudden death, and cardiovascular morbidity in the world.

These 2016 AFib Guidelines are based on the current state-of-the-art evidence 10 2016

Cardiovascular Pharmacology and Pharmacotherapy
Invasive Electrophysiology and Ablation
Atrial Fibrillation
Guidelines version available to download
Published in2016
ReferenceAFIB
Published in2012
ReferenceEuropean Heart Journal (2012) 33, 2719–2747
Published in2010
ReferenceEuropean Heart Journal (2010) 31, 2369–2429
Published in2012
ReferenceCorrigendum-AFib-Focused-Update-2012-EHJ-doi:10.1093/eurheartj/eht027
Published in2011
Referencedoi:10.1093/eurheartj/ehq512
Published in2016
ReferenceTable of Contents
  • PDA
  • Published in2016
    ReferencePocket Guidelines App
    Published in2012
    ReferenceSlides AFIB focused update 2012
    Published in2011
    Reference2010 Guidelines slides on AFIB
    Published in2012
    ReferenceCME Questions AFIB
    Published in2010
    ReferenceAFIB - Additional References
    Published in2011
    ReferenceESC Statement on Dronedarore
    Table of contents: Full Text (ESC Clinical Practice Guidelines)

    Abbreviations and acronyms

    Preamble       

    Introduction 

    Epidemiology and impact for patients      

    • Incidence and prevalence of atrial fibrillation  
    • Morbidity, mortality, and healthcare burden of atrial fibrillation           
    • Impact of evidence-based management on outcomes in atrial fibrillation patients      
    • Gender

    Pathophysiological and genetic aspects that guide management        

    • Genetic predisposition 
    • Mechanisms leading to atrial fibrillation          

    Diagnosis and timely detection of atrial fibrillation         

    • Overt and silent atrial fibrillation         
    • Screening for silent atrial fibrillation    
    • Electrocardiogram detection of atrial flutter    

    Classification of atrial fibrillation   

    • Atrial fibrillation pattern          
    • Atrial fibrillation types reflecting different causes of the arrhythmia    
    • Symptom burden in atrial fibrillation    

    Detection and management of risk factors and concomitant cardiovascular diseases           

    • Heart failure    
    • Hypertension   
    • Valvular heart disease
    • Diabetes mellitus
    • Obesity and weight loss          
    • Chronic obstructive pulmonary disease, sleep apnoea, and other respiratory diseases
    • Chronic kidney disease

    Integrated management of patients with atrial fibrillation

    • Evidence supporting integrated atrial fibrillation care  
    • Components of integrated atrial fibrillation care          
    • Diagnostic workup of atrial fibrillation patients
    • Structured follow-up   
    • Defining goals of atrial fibrillation management          

    Stroke prevention therapy in atrial fibrillation patients 

    • Prediction of stroke and bleeding risk 
    • Stroke prevention       
    • Left atrial appendage occlusion and exclusion 
    • Secondary stroke prevention   
    • Strategies to minimize bleeding on anticoagulant therapy      
    • Management of bleeding events in anticoagulated patients with atrial fibrillation       
    • Combination therapy with oral anticoagulants and antiplatelets          

    Rate control therapy in AF  

    • Acute rate control       
    • Long-term pharmacological rate control          
    • Heart rate targets in atrial fibrillation   
    • Atrioventricular node ablation and pacing       

    Rhythm control therapy in atrial fibrillation         

    • Acute restoration of sinus rhythm       
    • Long-term antiarrhythmic drug therapy          
    • Catheter ablation        
    • Atrial fibrillation surgery          
    • Choice of rhythm control following treatment failure   
    • The atrial fibrillation Heart Team         

    Hybrid rhythm control therapy

    • Combining antiarrhythmic drugs and catheter ablation           
    • Combining antiarrhythmic drugs and pacemakers       

    Specific situations   

    • Frail and ‘elderly’ patients       
    • Inherited cardiomyopathies, channelopathies, and accessory pathways          
    • Sports and atrial fibrillation     
    • Pregnancy       
    • Postoperative atrial fibrillation 
    • Atrial arrhythmias in grown-up patients with congenital heart disease
    • Management of atrial flutter   

    Patient involvement, education and self-management  

    • Patient-centred care   
    • Integrated patient education  
    • Self-management and shared decision-making          

    Gaps in evidence      

    • Major health modifiers causing atrial fibrillation
    • How much atrial fibrillation constitutes a mandate for therapy?          
    • Atrial high-rate episodes and need for anticoagulation
    • Stroke risk in specific populations       
    • Anticoagulation in patients with severe chronic kidney disease           
    • Left atrial appendage occlusion for stroke prevention  
    • Anticoagulation in atrial fibrillation patients after a bleeding or stroke event   
    • Anticoagulation and optimal timing of non-acute cardioversion          
    • Competing causes of stroke or transient ischaemic attack in atrial fibrillation patients
    • Anticoagulation in patients with biological heart valves (including transcatheter aortic valve implantation) and non-rheumatic valve disease          
    • Anticoagulation after ‘successful’ catheter ablation     
    • Comparison of rate control agents      
    • Catheter ablation in persistent and long-standing persistent AF         
    • Optimal technique for repeat catheter ablation
    • Combination therapy for maintenance of sinus rhythm           
    • Can rhythm control therapy convey a prognostic benefit in atrial fibrillation patients? 
    • Thoracoscopic ‘stand-alone’ atrial fibrillation surgery  
    • Surgical exclusion of the left atrial appendage
    • Concomitant atrial fibrillation surgery  

    To do and not to do messages from the Guidelines         

    A short summary of the management of AF patients      

     Web addenda


     

     

     

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