2012 Focused Update of the ESC Guidelines for the Management of Atrial Fibrillation: An Update of the 2010 ESC Guidelines for the Management of Atrial Fibrillation

Perspective:

The following are 10 points to remember from the update of the European Society of Cardiology atrial fibrillation (AF) guidelines:

1. Because of poor efficacy and the risk of bleeding complications, aspirin or aspirin/clopidogrel should be used for stroke prevention only in patients who refuse to take oral anticoagulants (OACs).

2. The CHA2DS2-VASc score is more accurate than the CHADS2 score for identifying low-risk patients.

3. Patients with lone AF under the age of 65 years do not require antithrombotic therapy.

4. An OAC should be considered when the CHA2DS2-VASc score is 1 and is recommended when the CHA2DS2-VASc is >1.

5. Because of better efficacy, safety, and convenience, dabigatran, rivaroxaban, or apixaban should be considered instead of warfarin for most AF patients.

6. Intravenous flecainide, propafenone, ibutilide, or vernakalant is recommended for pharmacological cardioversion in patients with minimal or no structural heart disease.

7. Dronedarone is an appropriate rhythm control agent in patients with paroxysmal or persistent AF, but is contraindicated in patients with permanent AF and in patients with moderate or severe heart failure.

8. Catheter ablation of symptomatic paroxysmal AF that has recurred despite antiarrhythmic drug therapy is recommended.

9. Catheter ablation of AF should be considered as first-line therapy for symptomatic paroxysmal AF in patients who prefer catheter ablation over antiarrhythmic drug therapy.

10. Uninterrupted therapy with warfarin should be considered in patients undergoing catheter ablation of AF.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Novel Agents, Statins, Acute Heart Failure

Keywords: Morpholines, Thiophenes, Warfarin, Ticlopidine, Risk Factors, Recurrence, beta-Alanine, Benzimidazoles, Flecainide, Pyridones, Risk Assessment, Sulfonamides, Stroke, Electric Countershock, Pyrazoles, Heart Failure, Pyrrolidines, Propafenone, Catheter Ablation, Hemorrhage


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