Atrial Fibrillation 2016 (Management of)

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