What you need to Know about Management of AF as a primary care physician

The 2020 ESC Guidelines for the Diagnosis and Management of Atrial Fibrillation recommend catheter ablation for AF symptom improvement (class I, level A), targeting pulmonary vein isolation (class I, level A)⁶.

AF Catheter Ablation as a First-line Therapy:

• Should be considered as first-line rhythm control therapy to improve symptoms in selected patients with symptomatic paroxysmal AF episodes (class IIa, level B)
• May be considered for persistent AF without major risk factors for AF recurrence (level IIb, level C)
• Is recommended to reverse LV dysfunction in AF patients when tachycardia-induced cardiomyopathy is highly probable, independent of their symptom status (class I, level A)
• Should be considered in selected AF patients with HF with reduced LVEF to improve survival and reduce HF hospitalization (class IIa, level B)⁶

2020 ESC Guidelines Highlights
Watch Prof. G. Hindricks explain key updates made to the ESC Guidelines for AF Management.
Please refer to the following link for additional guidance on which patients to refer for catheter ablation: 2020 ESC Guidelines on AF Management

AF is progressive is nature, with longer diagnosis-to-ablation times associated with markers of atrial remodelling².

For patients with symptomatic paroxysmal AF, antiarrhythmic drugs (AAD) are often prescribed as the first-line therapy. However, these drugs fail to prevent AF recurrence in up to 50% of patients³. Some of these patients go on to receive catheter ablation.

Importantly, prior studies suggest that a shorter diagnosis to ablation time is associated with lower rates of atrial arrythmia recurrence, repeat procedures, and cardiovascular hospitalisation^4-7. These observations paired with evidence that catheter ablation can halt AF progression more effectively than AAD therapy⁷ has sparked debate around the optimal first line therapy for symptomatic AF patients.

The positive results from the Cryo-FIRST study demonstrate Cryoballoon ablation is safe and superior to AAD therapy in reducing AF recurrence in this first line patient population¹.

AF DETECTION AND TREATMENT

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