Perspective:

This viewpoint article reviewed the differences in recommendations for management of atrial fibrillation between the American College of Cardiology Foundation/American Heart Association/Heart Rhythm Society (ACCF/AHA/HRS), the Canadian Cardiovascular Society (CCS), and the European Society of Cardiology (ESC). The following are nine of the differences:

1. The CCS emphasizes treatment of comorbidities such as hypertension and sleep apnea.

2. The ESC recommends a resting heart rate target of <110 bpm for heart rate control, the ACCF/AHA/HRS recommends this only if the ejection fraction is >40%, and the CCS recommends a resting heart rate target of <100 bpm.

3. The CCS recommends atrioventricular junction ablation (AVJA) for symptomatic patients with uncontrolled rates despite drug therapy, whereas the ESC recommends AVJA for patients with permanent AF who are candidates for cardiac resynchronization therapy.

4. The ACCF/AHA/HRS and ECS recommend avoidance of class IC antiarrhythmic drugs and sotalol in patients with left ventricular hypertrophy, while the CCS recommends avoiding these drugs if there are repolarization abnormalities on the electrocardiogram.

5. The ACCF/AHA/HRS and ECS recommend dronedarone to decrease the risk of hospitalization for cardiovascular causes, but the CCS does not.

6. The ESC recommends angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers for AF prevention, whereas the ACCF/AHA/HRS and the CCS do not.

7. The ACCF/AHA/HRS makes a class I recommendation for catheter ablation in patients with paroxysmal AF who fail a single antiarrhythmic drug, but the CCS and ESC have this as a class IIA recommendation.

8. The ACCF/AHA/HRS and ECS recommend clopidogrel plus aspirin for patients who refuse warfarin therapy, whereas the CCS recommends dabigatran.

9. The ACCF/AHA/HRS and CCS recommend the CHADS₂ score as a guide for stroke prevention, while the ESC recommends the CHA₂DS₂-VASc score.