Spotlight on the 2024 ESC/EACTS management of atrial fibrillation guidelines: 10 novel key aspects
Rienstra, Michiel Tzeis, Stylianos Bunting, Karina V Caso, Valeria Crijns, Harry J G M De Potter, Tom J R Sanders, Prashanthan Svennberg, Emma Casado-Arroyo, Ruben Dwight, Jeremy
Rienstra, Michiel
Tzeis, Stylianos
Bunting, Karina V
Caso, Valeria
Crijns, Harry J G M
De Potter, Tom J R
Sanders, Prashanthan
Svennberg, Emma
Casado-Arroyo, Ruben
Dwight, Jeremy
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Affiliation
University of Groningen; University Medical Center Groningen; Mitera Hospital; University of Birmingham; Santa Maria della Misericordia-University of Perugia; Maastricht University Medical Center; Maastricht University; OLV Hospital; University of Adelaide; Royal Adelaide Hospital, Adelaide; Karolinska Institutet; Karolinska University Hospital; H.U.B.-Hôpital Erasme; Université Libre de Bruxelles; Sophia Antipolis; University of Insubria; ASST-Settelaghi; Asklepios Klinikum; Linkoping University; University Medical Center Utrecht; Fondazione IRCCS San Gerardo dei Tintori; The Arctic University of Norway; University Hospital of North Norway; University College London; Barts Health NHS Trust; University College London Hospitals NHS Trust; San Raffaele University of Rome; San Raffaele Cassino Hospital; St George's University Medical School; University Medical Center Hamburg-Eppendorf; German Center for Cardiovascular Research; National Medical Institute of the Ministry of Interior and Administration; Universidad Complutense; Emergency County Clinical Hospital of Bihor; Acibadem City Clinic Tokuda University Hospital; University Hospitals Birmingham NHS Foundation Trust
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Publication date
2024-12-24
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Abstract
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.
Citation
Rienstra M, Tzeis S, Bunting KV, Caso V, Crijns HJGM, De Potter TJR, Sanders P, Svennberg E, Casado-Arroyo R, Dwight J, Guasti L, Hanke T, Jaarsma T, Lettino M, Løchen ML, Lumbers RT, Maesen B, Mølgaard I, Rosano GMC, Schnabel RB, Suwalski P, Tamargo J, Tica O, Traykov V, Kotecha D, Van Gelder IC. Spotlight on the 2024 ESC/EACTS management of atrial fibrillation guidelines: 10 novel key aspects. Europace. 2024 Dec 3;26(12):euae298. doi: 10.1093/europace/euae298.
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Article