2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation

Joglar, José A.; Chung, Mina K.; Armbruster, Anastasia L.; Benjamin, Emelia J.; Chyou, Janice Y.; Cronin, Edmond M.; Deswal, Anita; Eckhardt, Lee L.; Goldberger, Zachary D.; Gopinathannair, Rakesh; Gorenek, Bulent; Hess, Paul L.; Hlatky, Mark; Hogan, Gail; Ibeh, Chinwe; Indik, Julia H.; Kido, Kazuhiko; Kusumoto, Fred; Link, Mark S.; Linta, Kathleen T.; Marcus, Gregory M.; McCarthy, Patrick M.; Patel, Nimesh; Patton, Kristen K.; Perez, Marco V.; Piccini, Jonathan P.; Russo, Andrea M.; Sanders, Prashanthan; Streur, Megan M.; Thomas, Kevin L.; Times, Sabrina; Tisdale, James E.; Valente, Anne Marie; Van Wagoner, David R.; Krahn, Andrew D.; Andrade, Jason G.; Beavers, Craig J.; Bischoff, James M.; Bunch, T. Jared; Campbell, Kristen Bova; Chen, Lin Yee; Dharia, Robin; Dorsch, Michael P.; Gerstenfeld, Edward P.; Jones, Aubrey E.; Kaluzna, Stephanie Dwyer; Masha, Luke; Nault, Isabelle; Noseworthy, Peter A.; Pellegrini, Cara N.; Tzeis, Stylianos E.; Volgman, Annabelle Santos; Zeitler, Emily P.

doi:10.1016/j.jacc.2023.08.017

Cited by 186 publications

(8 citation statements)

References 1,216 publications

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“…Conversely, our study elucidates the effects of AADs or electrical cardioversion for sinus conversion in patients with AF and reduced LVEF, showcasing the feasibility and effectiveness of a long-term rhythm control strategy, including AADs and/or catheter ablation, depending on the recurrence of AF. Moreover, in response to these findings, recent guidelines for AF management have been updated to recommend catheter ablation for rhythm control as a class I indication in AF patients with HF with reduced LVEF [21]. However, at the time our study patients were treated for AF and HF, catheter ablation was not the recommended first choice for rhythm control.…”

Section: Discussionmentioning

confidence: 96%

Real-World Outcomes of a Rhythm Control Strategy for Atrial Fibrillation Patients with Reduced Left Ventricular Ejection Fraction (<50%)

Choi,

Kwon

2024

JCM

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Background/Objectives: The effectiveness of a rhythm control strategy in patients with atrial fibrillation (AF) and reduced left ventricular ejection fraction (LVEF < 50%) in real-world practice remains uncertain. Our objective was to evaluate the real-world outcomes of a rhythm control strategy in patients with AF and reduced LVEF, focusing on changes in LV systolic function and brain natriuretic peptide (BNP) levels. Methods: The study retrospectively reviewed the medical records of 80 patients with concurrent AF and reduced LVEF who underwent rhythm control therapy between March 2015 and December 2021. Results: The patients had an average age of 63.6 years and an initial LVEF of 34.3%. Sinus rhythm was restored using anti-arrhythmic drugs (38, 47.5%) or electrical cardioversion (42, 52.5%). Over a follow-up period of 53.0 months, AF recurred in 65% of patients, with 57.7% undergoing catheter ablation. Significant improvements were noted in LVEF (from 34.3% to 55.1%, p < 0.001) and BNP levels (from 752 pg/mL to 72 pg/mL, p < 0.001) at the last follow-up. Nearly all patients (97.5%) continued with the rhythm control strategy during the follow-up period. Conclusions: In real-world settings, a rhythm control strategy proves to be feasible and effective for improving LVEF and reducing BNP levels in AF patients with reduced LVEF.

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Section: Discussionmentioning

confidence: 96%

Real-World Outcomes of a Rhythm Control Strategy for Atrial Fibrillation Patients with Reduced Left Ventricular Ejection Fraction (<50%)

Choi,

Kwon

2024

JCM

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“…Guidelines universally recommend the use of oral anticoagulant agents, including vitamin K antagonists and direct oral anticoagulants, for patients with AF at moderate and high risks of stroke. 1,2 Estimating stroke risk is commonly performed for both clinical and research purposes using simple scoring systems that assign points for various comorbidity and demographic elements: CHA 2 DS 2 -VASc. 3 This easy-to-calculate score then provides a yearly estimate of stroke risk for patients.…”

Section: Editorialmentioning

confidence: 99%

When Is a Simple Score Simply Good Enough? Comparing Stroke Risk Estimation in Atrial Fibrillation

Barnes

2024

Circ: Cardiovascular Quality and Outcomes

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“…Atrial fibrillation (AF) is a common form of cardiac arrhythmia increasingly treated with radiofrequency (RF) pulmonary vein isolation (PVI) ablation. 1 As new technologies continue to emerge, improving procedural efficacy while maintaining procedural safety remains paramount. Procedural efficacy, as measured by long-term freedom from arrhythmia, has been shown to increase with improved contiguity of lesion placement.…”

Section: Introductionmentioning

confidence: 99%

Reduced Continuity Index with Proactive Esophageal Cooling Compared to Luminal Temperature Monitoring During Radiofrequency Ablation

Lazarus,

Sherman,

Putzel

et al. 2024

Preprint

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Background: Proactive esophageal cooling is FDA cleared to reduce the likelihood of esophageal injury during radiofrequency ablation for treatment of atrial fibrillation (AF). Long-term follow-up data have also shown improved freedom from arrhythmia with proactive esophageal cooling compared to luminal esophageal temperature (LET) monitoring during pulmonary vein isolation (PVI). One hypothesized mechanism is improved lesion contiguity (as measured by the Continuity Index) with the use of cooling. We aimed to compare the Continuity Index of PVI cases using proactive esophageal cooling to those using LET monitoring. Methods: Continuity Index was calculated for PVI cases at two different hospitals within the same health system using a slightly modified Continuity Index to facilitate both real-time calculation during observation of PVI cases and retrospective determination from recorded cases. The results were then compared between proactively cooled cases and those using LET monitoring. Results: Continuity Indices for a total of 101 cases were obtained; 77 cases using proactive esophageal cooling and 24 cases using traditional LET monitoring. With proactive esophageal cooling, the average Continuity Index was 2.7 (1.3 on the left pulmonary vein, and 1.5 on the right pulmonary vein). With LET monitoring, the average Continuity Index was 27.3 (14.3 on the left, and 12.9 on the right), for a difference of 24.6 (p < 0.001). Conclusion: Proactive esophageal cooling during PVI is associated with significantly improved lesion contiguity when compared to LET monitoring. This finding may offer a mechanism for the greater freedom from arrhythmia seen with proactive cooling in long-term follow-up.

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2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation

Cited by 186 publications

References 1,216 publications

Real-World Outcomes of a Rhythm Control Strategy for Atrial Fibrillation Patients with Reduced Left Ventricular Ejection Fraction (<50%)

Real-World Outcomes of a Rhythm Control Strategy for Atrial Fibrillation Patients with Reduced Left Ventricular Ejection Fraction (<50%)

When Is a Simple Score Simply Good Enough? Comparing Stroke Risk Estimation in Atrial Fibrillation

Reduced Continuity Index with Proactive Esophageal Cooling Compared to Luminal Temperature Monitoring During Radiofrequency Ablation

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