Review of the 2020 ESC Guidelines for the Diagnosis and Management of Atrial Fibrillation—What Has Changed and How Does This Affect Daily Practice

Abstract

The high prevalence of atrial fibrillation (AF) in the overall population and its association with substantial morbidity, increased mortality and health care cost has instigated significant basic and clinical research efforts over recent years. The publication of multiple new high-quality randomized multi-center trials in the area of AF management and the rapidly evolving technological progress in terms of diagnostic possibilities and catheter ablation in recent years demanded a revision of the previous ESC AF Guidelines from 2016. The 2020 guidelines provide up-to-date, evidence-based guidance for the management of AF. One of the most important innovations is the presentation of a new concept for structural characterization of AF (the “4S AF scheme”) replacing the traditional classification based on its temporal pattern alone (paroxysmal-persistent-permanent). The 4S-AF-scheme highlights the importance of systematic assessment of stroke risk, severity of symptoms, total AF burden and underlying substrate as the foundation for effective and individualized AF treatment for each and every patient. Further novelties relate to the presentation of an easy and intuitive management pathway (“ABC pathway”) and strengthening the recommendations for early rhythm control, in particular the role of first line catheter ablation in heart failure. Another core component of the guidelines is the focus on patient involvement to achieve optimal outcomes. Patient education, shared decision making and incorporation of patient values and patient reported outcome of treatment interventions as well as integrated care by a multidisciplinary team all have a central role in the proposed management pathway for AF.

Using Minimum Redundancy Maximum Relevance Algorithm to Select Minimal Sets of Heart Rate Variability Parameters for Atrial Fibrillation Detection

“…Atrial fibrillation (AF) is characterized by the less organized and nearly random electrical activity of both atria accompanied by an irregular ventricular rhythm. [ 1 , 2 , 3 ]. AF can be either asymptomatic in many patients unaware of its existence or entirely symptomatic with paroxysmal or persistent palpitations, dyspnea, angina, worsened exercise tolerance, and occasional syncope [ 2 , 3 ].…”

“…[ 1 , 2 , 3 ]. AF can be either asymptomatic in many patients unaware of its existence or entirely symptomatic with paroxysmal or persistent palpitations, dyspnea, angina, worsened exercise tolerance, and occasional syncope [ 2 , 3 ]. This arrhythmia is associated with a significantly increased risk of heart failure, cognitive decline due to vascular dementia, ischemic stroke, and premature death [ 2 , 3 ].…”

“…AF is the most common sustained cardiac arrhythmia, particularly in older people and those with cardiovascular risk factors such as hypertension, diabetes, smoking, coronary artery disease, or obesity [ 2 , 3 , 4 ]. It is usually a consequence of structural and/or functional changes in the left atrium or both atria [ 2 , 3 , 4 ].…”

Comparison of the Efficacy and Safety Endpoints of Five Therapies for Atrial Fibrillation: A Network Meta-Analysis

“…According to the 2020 European Society of Cardiology (ESC) guideline for the diagnosis and management of AF, rhythm control for reducing symptom onset and improving life quality is recommended at the class IA evidence level (4). Furthermore, a recent study proved that rhythm control is also beneficial to patients in terms of preventing stroke, coronary syndromes, heart failure, and cardiovascular death (5). In addition to traditional drug therapies, various instrumental treatments have been developed, facilitating more effective pathways for rhythm control in patients with AF.…”

“…In addition to traditional drug therapies, various instrumental treatments have been developed, facilitating more effective pathways for rhythm control in patients with AF. The SARA study in 2014 proved that catheter radiofrequency ablation (RFA) is more efficient than drug therapy in reducing AF recurrence (5). Furthermore, cryoballoon ablation (CBA), which was invented to achieve better circumferential pulmonary vein isolation than traditional point-by-point-RFA, exhibits a higher procedure success rate than traditional drug therapy (6); however, there was no difference in efficacy endpoint at 1-year followup between patients receiving RFA and CBA.…”