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Atrial Fibrillation (Management of) Guidelines

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, heart failure, sudden death, and cardiovascular morbidity in the world.

These 2016 atrial fibrillation guidelines were based on the current state-of-the-art evidence in 2016.

Arrhythmias, General
Antiarrhythmic Pharmacotherapy
Atrial Fibrillation
Pharmacology and Pharmacotherapy
Invasive Imaging and Functional Assessment
Arrhythmias and Device Therapy
Guidelines version available to download
Published in 2016
Reference European Heart Journal (2016) 37, 2893–2962 doi:10.1093/eurheartj/ehw210
Published in 2016
Reference .doi:10.1093/eurheartj/ehw21
Published in 2020
Reference Memo Card AFIB
Published in 2016
Reference Eur Heart J (2016) 37 (38): 2893-2962-
Published in 2017
Reference Essential Messages
Published in 2016
Reference Table of Contents
Published in 2016
Reference Pocket Guidelines App
Published in 2016
Reference 85 Slides
Table of contents: Full Text (ESC Clinical Practice Guidelines)

Abbreviations and acronyms



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

Previous version available to download
Published in 2012
Reference Corrigendum-AFib-Focused-Update-2012-EHJ-doi:10.1093/eurheartj/eht027
Published in 2012
Reference European Heart Journal (2012) 33, 2719–2747
Published in 2011
Reference doi:10.1093/eurheartj/ehq512
Published in 2010
Reference European Heart Journal (2010) 31, 2369–2429
Published in 2010
Reference AFIB - Additional References
Published in 2011
Reference ESC Statement on Dronedarore