Longer and better lives for patients with atrial fibrillation: the 9th AFNET/EHRA consensus conference

Abstract

Aims Recent trial data demonstrate beneficial effects of active rhythm management in patients with atrial fibrillation (AF) and support the concept that a low arrhythmia burden is associated with a low risk of AF-related complications. The aim of this document is to summarize the key outcomes of the 9th AFNET/EHRA Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA). Methods and results Eighty-three international experts met in Münster for 2 days in September 2023. Key findings are as follows: (i) Active rhythm management should be part of the default initial treatment for all suitable patients with AF. (ii) Patients with device-detected AF have a low burden of AF and a low risk of stroke. Anticoagulation prevents some strokes and also increases major but non-lethal bleeding. (iii) More research is needed to improve stroke risk prediction in patients with AF, especially in those with a low AF burden. Biomolecules, genetics, and imaging can support this. (iv) The presence of AF should trigger systematic workup and comprehensive treatment of concomitant cardiovascular conditions. (v) Machine learning algorithms have been used to improve detection or likely development of AF. Cooperation between clinicians and data scientists is needed to leverage the potential of data science applications for patients with AF. Conclusions Patients with AF and a low arrhythmia burden have a lower risk of stroke and other cardiovascular events than those with a high arrhythmia burden. Combining active rhythm control, anticoagulation, rate control, and therapy of concomitant cardiovascular conditions can improve the lives of patients with AF.

Causes of death in patients with atrial fibrillation anticoagulated with rivaroxaban: a pooled analysis of XANTUS

“… 34 A call for a broader use of rhythm control also came out of the 9th AFNET/EHRA consensus document. 35 Our data illustrate the potential for rhythm control interventions, and for holistic AF care, to further reduce cardiovascular events in anticoagulated patients with AF.…”

Design and deployment of the STEEER-AF trial to evaluate and improve guideline adherence: a cluster-randomized trial by the European Society of Cardiology and European Heart Rhythm Association

“…This paper outlines the key design features of the STEEER-AF trial that were essential to objectively evaluate the extent of guideline adherence in real-world clinical practice and test whether structured education could optimize patient-level guideline adherence. Atrial fibrillation was chosen as the topic for the ESC’s first clinical trial due to its association with preventable adverse outcomes, 17 , 18 evolving options for management, 19–21 and the observation of better prognosis when patient care is adherent to guidelines. The evidence base for guideline-adherent care is largely restricted to anticoagulation use in AF and previously based on non-randomized studies where selection biases were likely substantial.…”

Great debate: device-detected subclinical atrial fibrillation should be treated like clinical atrial fibrillation

“… 6 The new term ‘device-detected’ AF has been suggested to replace ‘subclinical’ to better describe the entity. 7 …”