Contemporary Atrial Fibrillation Management – A comparison of the current AHA/ACC/HRS, CCS, and ESC guidelines

• Published in: Canadian journal of cardiology Vol. 33; no. 8; pp. 965 - 976
• Main Authors: Andrade, Jason G., MD, Macle, Laurent, MD, Nattel, Stanley, MD, Verma, Atul, MD, Cairns, John, MD
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01-08-2017
• Subjects: American Heart Association; Atrial Fibrillation - therapy; Canada; Cardiology; Cardiovascular; Disease Management; Europe; Humans; Practice Guidelines as Topic; Societies, Medical; United States
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2017.06.002

Abstract This article compares and contrasts the current recommendations, and highlights the important differences, in the American College of Cardiology (ACC)/American Heart Association (AHA)/Heart Rhythm Society (HRS), European Society of Cardiology (ESC), and Canadian Cardiovascular Society (CCS) atrial fibrillation (AF) guidelines. Although many of the recommendations of the various societies are similar, there are important differences in the methodologies underlying their development and the specific content. Specifically, key differences can be observed in: 1) the definition of non-valvular AF, which subsequently impacts anticoagulation choices and candidacy for non-vitamin K antagonist oral anticoagulants (NOACs); 2) the symptom-score used to guide management decisions and longitudinal patient profiling; 3) the stroke-risk stratification algorithm used to determine indications for OAC therapy; 4) the role of ASA in stroke prevention in AF; 5) the antithrombotic regimens employed in the context of coronary artery disease, acute coronary syndromes, and percutaneous coronary intervention; 6) the rate control target and medications recommended to achieve the target; and 7) the role of “first-line” catheter ablation, open surgical ablation, and left atrial appendage exclusion.