Management of atrial fibrillation: What is new in the 2014 ACC/AHA/HRS guideline?

Abstract

Recently, the American College of Cardiology, the American Heart Association, and the Heart Rhythm Society published an updated guideline on the management of atrial fibrillation (AF). This document is a complete revision of the 2006 guideline. Prominent changes in the 2014 guideline include the use of the CHA₂DS₂-VASc score for risk stratification of stroke, recommendations on when and how to use newer oral anticoagulants for thromboprophylaxis, downgrading of the use of aspirin for thromboprophylaxis of moderate-risk patients, and the use of catheter ablation in selected patients as first-line therapy for paroxysmal AF. In regard to rate control, the 2014 guideline reverts back to a previous recommendation for stricter targets for mean and maximum heart rate on therapy. The current guideline incorporates many recent trials in updating existing recommendations from the 2006 guideline. The 2014 guideline will be a vital tool in guiding physicians in the management of AF.

Keywords:

• Atrial fibrillation
• guidelines
• anticoagulation
• catheter ablation

Declaration of interest

AB Curtis is on advisory boards for St. Jude Medical, Sanofi Aventis, Janssen Pharmaceuticals, Pfizer Inc., and Daiichi Sankyo. AB Curtis has also been a consultant for Sanofi Aventis and Medtronic Inc., and a speaker for St. Jude Medical and Medtronic Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

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