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7 Key Points of the new “2023 Guideline for the Diagnosis & Management of Atrial Fibrillation”

This is my second report on the new “2023 Guideline for the Diagnosis & Management of Atrial Fibrillation” published in January 2024. The updated recommendations was a collaborated effort by cardiologists, electrophysiologists, surgeons, pharmacists, patient representatives and other stakeholders. The Guideline was last updated in 2014 and supplemented in 2019.
In my first report, I wrote why the new Guideline is important to all A-Fib patients and covered a few of the important updates. It includes new evidence to guide your cardiologist and electrophysiologist in the treatment of your Atrial Fibrillation.

7 Key Points For Patients to Know

After writing my first report, I continued to study the Guideline (it’s 171 pages after all).

This second report contains several important key points that may influence how you interact with your electrophysiologist and cardiologist. And can affect your choice of which A-Fib treatment(s) is right for you.

To be an informed patient, the main points you should know are:

1. As before, catheter ablation is recognized as first-line therapy for most A-Fib patients.

What that means is that you no longer have to undergo months or a year on antiarrhythmic (drug) therapy before you can have a catheter ablation. Even if you’ve just been diagnosed with A-Fib, you can choose to have a catheter ablation as your first treatment option.

From the Guideline: “Catheter ablation is useful as first-line therapy to improve symptoms and reduce progression to persistent AF.”

“Early rhythm control is associated with a greater likelihood of maintaining sinus rhythm in the long term and minimizing AF burden and reducing the progression of the disease.” And it reduces the likelihood of dementia onset.

2. The Guideline emphasizes the use of catheter ablation (CA) early in the treatment of A-Fib. Studies show an early catheter ablation is beneficial particularly in patients with heart failure.

3. Warfarin is no longer a recommended anticoagulant. Direct oral anticoagulants (DOAC) are preferred over warfarin (with the exception of certain patients with, for example, a mechanical heart valve).

4. Aspirin is no longer recommended as an anticoagulant. “Aspirin…alone as an alternative to anticoagulation is not recommended to reduce stroke risk.”

5. The guideline recognizes that clots take time to form (e.g. “lasting ≥24 hours”). Before, it was thought that even a short A-Fib episode (less than 5 minutes) could cause a clot and stroke.

Under the new guideline, for most patients whose A-Fib episodes last less than 5 minutes should not receive Oral Anticoagulant.

6. Important recognition: The benefits of Left Atrial Appendage Occlusion devices (i.e., Watchman, Amplatzer, etc.) may be a reasonable alternative to an Oral Anticoagulant.

7. The Guideline recognizes that “A-Fib burden” (how severe your A-Fib is and how it affects you) is an important factor in the treatment of your A-Fib.

Read it Yourself

If you haven’t already read it, I recommend you read my first report.

Also, if you want to review the Guideline yourself, the entire document is on the The Journal American College of Cardiology website. It includes a Table of Contents so you can jump to and read a particular section. Footnotes are included and linked to a 32-page Reference section as well as Appendices.

You can also download a copy of the 171 page Guideline as in a .PDF document and review it at your leisure.

Research
• Crawford, Thomas E. et al. 2023 Guidelines for Diagnosis and Management of Atrial Fibrillation: Key Perspectives. American College of Cardiology, Nov. 30, 2023. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2023/11/27/19/46/2023-acc-guideline-for-af-gl-af

• Joglar, Jose A. et al. 2023 ACC/AHA/ACCP/HRS Guidelines for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines Circulation Vol. 149, No.1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193

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