2020 ESC Guidelines for the diagnosis and management of atrial fibrillation Review article

Abstract

This year’s ESC Congress presented new guidelines for the diagnosis and management of atrial fibrillation. AF is the most common sustained arrhythmia which prevalence increases with age. A new AF integrated care was presented as CC To ABC pathway. That acronym stands for: confirm, characterise and treatment: anticoagulation, better symptom control, comorbidities and cardiovascular risk factors management. Structured patient’s characterisation includes clinical assessment of: stroke risk, symptom severity, severity of AF burden, substrate severity. That approach is called 4S scheme. Main anticoagulation guidelines are focused on increasing role of NOACs and managements of atrial fibrillation patients undergoing an uncomplicated percutaneous coronary intervention. Rhythm control recommendations are enhancing the role of catheter ablation for pulmonary vein isolation to improve symptoms of atrial fibrillation. Pulmonary vein isolation is recommended after antiarrhythmic drug therapy intolerance or failure, independent of type and recurrence risk of atrial fibrillation. What is new is the proposition of consideration pulmonary vein isolation as a I line therapy to improve symptoms in symptomatic patients. To reduce atrial fibrillation recurrence it is recommended to inform patients about its modifiable risk factors. The most important are: weight loss and management of obstructive sleep apnea. Guidelines also recommend considering opportunistic screening of patients under 65 years old, hypertensive and patients with obstructive sleep apnea. Besides, the article describes results of two trials which emphasize the role of early rhythm-control therapy and the role of digoxin for rate-control.