American College of Cardiology

FUSTER ET AL., ACC/AHA/ESC GUIDELINES FOR THE MANAGEMENT OF PATIENTS WITH ATRIAL FIBRILLATION
J Am Coll Cardiol 2001;38:1266i-1xx

ACC/AHA/ESC Guidelines for the Management of Patients with Atrial Fibrillation

A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee to Develop Guidelines for the Management of Patients with Atrial Fibrillation

Developed in Collaboration with the North American Society of Pacing and Electrophysiology

Committee Members
Valentin Fuster, MD, PhD, FACC, Chair; Lars E. Rydén, MD, PhD, FACC, FESC, Co-Chair; Richard W. Asinger, MD, FACC; David S. Cannom, MD, FACC; Harry J. Crijns, MD, FESC; Robert L. Frye, MD, MACC; Jonathan L. Halperin, MD, FACC; G. Neal Kay, MD, FACC; Werner W. Klein, MD, FACC, FESC; Samuel Lévy, MD, FACC, FESC; Robert L. McNamara, MD, MHS, FACC; Eric N. Prystowsky, MD, FACC; L. Samuel Wann, MD, FACC; D. George Wyse, MD, PhD, FACC

Task Force Members
Raymond J. Gibbons, MD, FACC, Chair; Elliott M. Antman, MD, FACC, Vice Chair; Joseph S. Alpert, MD, FACC; David P. Faxon, MD, FACC; Valentin Fuster, MD, PhD, FACC; Gabriel Gregoratos, MD, FACC; Loren F. Hiratzka, MD, FACC; Richard O. Russell, MD, FACC*; Sidney C. Smith, Jr, MD, FACC

*Former Task Force Member during this effort.

ESC Committee for Practice Guidelines & Policy Conferences Members
Werner W. Klein, MD, FACC, FESC, Chair; Angeles Alonso-Garcia, MD, FACC, FESC; Carina Blomström-Lundqvist, MD, PhD, FESC; Guy De Backer, MD, PHD, FACC, FESC; Marcus Flather, MD, FESC; Jaromir Hradec, MD, FESC; Ali Oto, MD, FACC, FESC; Alexander Parkhomenko, MD, FESC; Sigmund Silber, MD, PhD, FESC; Adam Torbicki, MD, FESC

Contents:

Preamble

I. Introduction

1. Organization of Committee and Evidence Review
2. Contents of these Guidelines

II. Definition

1. Atrial Fibrillation
2. Related Arrhythmias

III. Classification

IV. Epidemiology and Prognosis

1. Prevalence
2. Incidence
3. Prognosis

V. Pathophysiological Mechanisms

1. Atrial Factors
   1. Pathology of the Atrium in Patients with AF
   2. Mechanisms of AF
2. AV Conduction
   1. General Aspects
   2. AV Conduction in the WPW Syndrome
3. Myocardial and Hemodynamic Consequences of AF
4. Thromboembolism
   1. Pathophysiology of Thrombus Formation
   2. Clinical Implications

VI. Associated Conditions, Clinical Manifestations and Quality of Life

1. Causes and Associated Conditions
   1. Acute Causes of AF
   2. AF Without Associated Heart Disease
   3. AF With Associated Heart Disease
   4. Neurogenic AF
2. Clinical Manifestations
3. Quality of Life

VII. Clinical Evaluation

1. Minimum Evaluation of the Patient with AF
   1. Clinical History and Physical Examination
   2. Investigations
2. Additional Investigation of Selected Patients with AF
   1. Holter Monitoring and Exercise Testing
   2. Transesophageal Echocardiography
   3. Electrophysiological Study

VIII. Management

1. Rhythm Control vs. Heart Rate Control
2. Cardioversion
   1. Basis for Cardioversion of AF
   2. Methods of Cardioversion
3. Pharmacological Cardioversion
   1. Agents with Proven Efficacy
   2. Less Effective or Incompletely Studied Agents
4. Electrical Cardioversion
   1. Terminology
   2. Technical Aspects
   3. Clinical Aspects
   4. Transvenous Electrical Cardioversion
   5. Electrical Cardioversion in Patients With Implanted Pacemakers and Defibrillators
   6. Risks and Complications
   Recommendations for Pharmacological or Electrical Cardioversion of AF

5. Maintenance of Sinus Rhythm
   1. Pharmacological Therapy to Prevent Recurrence of AF
   2. General Approach to Antiarrhythmic Drug Therapy
   3. Pharmacological Agents to Maintain Sinus Rhythm
   4. Out-of-Hospital Initiation of Antiarrhythmic Drugs in Patients with AF
   5. Recurrence of AF After Cardioversion: Implications for Drug Treatment
   6. Selection of Antiarrhythmic Agents in Patients With Certain Cardiac Diseases
   Recommendations for Pharmacological Therapy to Maintain Sinus Rhythm
   7. Nonpharmacological Correction of AF
6. Rate Control During AF
1. Pharmacological Approaches
2. Nonpharmacological Regulation of AV Nodal Conduction and Pacing
3. Nonpharmacological/AV Nodal Ablation

Recommendations for Heart Rate Control in Patients with AF

5. Preventing Thromboembolism

1. Risk Stratification
2. Antithrombotic Strategies for Prevention of Ischemic Stroke and Systemic Embolism

Recommendations for Antithrombotic Therapy in Patients with AF

3. Conversion to Sinus Rhythm and Thromboembolism

Recommendations for Antithrombotic Therapy to Prevent Ischemic Stroke and Systemic Embolism in Patients with AF Undergoing Cardioversion

8. Special Considerations
   1. Postoperative AF
   Recommendations for Prevention and Management of Postoperative AF
   2. Acute MI
   Recommendations for Management of Patients with AF and Acute MI
   3. WPW Preexcitation Syndromes
   Recommendations for Management of AF and Ventricular Preexcitation
   4. Hyperthyroidism
   Recommendations for Management of AF in Patients With Hyperthyroidism
   5. Pregnancy
   Recommendations for Management of AF During Pregnancy
   6. Hypertrophic Cardiomyopathy
   Recommendations for Management of AF in Patients With HCM
   7. Pulmonary Diseases
   Recommendations for Management of AF in Patients With Pulmonary Diseases

9. Primary Prevention

IX. Proposed Management Strategies

1. Overview of Algorithms for Management of Patients With AF
   1. Newly Discovered AF
   2. Recurrent Paroxysmal AF
   3. Recurrent Persistent AF
   4. Permanent AF

References

Figures & Tables

Staff

This document was approved by the American College of Cardiology Board of Trustees in August 2001, the American Heart Association Science Advisory and Coordinating Committee in August 2001, and the European Society of Cardiology Board and Committee for Practice Guidelines and Policy Conferences in August 2001.

When citing this document, the American College of Cardiology, the American Heart Association, and the European Society of Cardiology would appreciate the following citation format: Fuster V, Rydén LE, Asinger RW, Cannom DS, Crijns HJ, Frye RL, Halperin JL, Kay GN, Klein WW, Lévy S, McNamara RL, Prystowsky EN, Wann LS, Wyse DG. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation). J Am Coll Cardiol 2001;38:1266i-lxx.

This document is available on the World Wide Web sites of the American College of Cardiology, the American Heart Association, the European Society of Cardiology, and the North American Society of Pacing and Electrophysiology. Single reprints of this document (the complete Guidelines) to be published in the mid-October issue of the European Heart Journal are available by calling 144.207.424.4200 or 144.207.424.4389, faxing 144.207.424.4433, or writing Harcourt Publishers Ltd, European Heart Journal, ESC Guidelines - Reprints, 32 Jamestown Road, London, NW1 7BY, United Kingdom. Single reprints of the shorter version (Executive Summary and Summary of Recommendations) published in the October issue of the Journal of the American College of Cardiology and the October 23 issue of Circulation, are available for $5.00 each by calling 800-253-4636 (US only) or by writing the Resource Center, American College of Cardiology, 9111 Old Georgetown Road, Bethesda, Maryland 20814. To purchase bulk reprints specify version and reprint number (Executive Summary 71-0208; full text 71-0209) up to 999 copies, call 800-611-6083 (US only) or fax 413-665-2671; 1000 or more copies, call 214-706-1466, fax 214-691-6342; or E-mail: pubauth@heart.org.

Copyright © 2001 by the American College of Cardiology, American Heart Association, Inc., and the European Society of Cardiology

Published by Elsevier Science Inc.