ESC Congress FA eBook 2016 - 2

FEATURED ARTICLE

ESC 2016 Atrial Fibrillation Guidelines
Emphasize Multidisciplinary
and Patient-Centered Care
Written by Toni Rizzo

The 2016 European Society of Cardiology (ESC) guidelines for the management of atrial fibrillation (AF) were developed by ESC Task Force members with contributions from the European
Association of Cardio-Thoracic Surgeons (EACTS) and the European Stroke Organization (ESO)
[Kirchhof P et al. Eur Heart J. 2016]. The goal of the guidelines is to achieve optimal management
of patients with AF by providing all therapy options, measurable high-quality service, multidisciplinary input, and optimal care that is accessible for all patients.
The guidelines recommend a comprehensive treatment approach using five domains: acute rate
and rhythm control; management of precipitating factors and comorbidities; stroke prevention; control of heart rate; and assessment of symptoms to appropriately select rhythm control approaches
(antiarrhythmic drugs, catheter ablation, hybrid ablation and surgical ablation; Figure 1).
INITIAL APPROACH TO AF

Official Peer-Reviewed
Highlights From

AF is common and its prevalence is increasing exponentially. In some patients, AF can be silent
and asymptomatic, especially in the elderly. Stroke, myocardial infarction, and heart failure (HF)
are more common in patients with AF, and 10% to 40% of patients with AF are hospitalized each
year. All-cause mortality is increased 2-fold in women with AF and 1.5-fold in men with AF. Barbara
Casadei, MD, University of Oxford, Oxford, United Kingdom, discussed the initial approach, goals,
and expectations in managing AF.
The 2016 guidelines recommend opportunistic screening for AF by pulse check or electrocardiogram rhythm strip assessment in patients aged > 65 years, and systematic screening in patients at
risk for AF or stroke (eg, prior stroke, HF or age > 75 years). For patients with an implanted device,
the guidelines recommend interrogating pacemakers and implantable cardioverter devices (ICDs)

Figure 1. The Five Domains of Atrial Fibrillation Management
Treatment

Acute rate
and rhythm
control

Desired outcome

Hemodynamic
stability

(eg, β-blockers,
cardioversion)

Manage
precipitating
factors

Lifestyle changes, treatment
of underlying cardiovascular
conditions

Assess
stroke risk

Patient benefit

Oral anticoagulation in
patients at risk for stroke

Assess
heart rate

Assess
symptoms

Rate control therapy

Antiarrhythmic drugs,
cardioversion, catheter
ablation, AF surgery

Cardiovascular risk
reduction

Improved life
expectancy

Stroke prevention
Symptom improvement,
preservation of
LV function

Improved quality
of life, autonomy,
social functioning

Symptom
improvement

AF, atrial fibrillation; LV, left ventricular.
Reprinted from Kirchhof P et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016.
doi:10.1093/eurheartj/ehw210. By permission of Oxford University Press on behalf of the European Society of Cardiology.

October 2016

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