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.