2016 Guidelines of the Taiwan Heart Rhythm Society and the Taiwan Society of Cardiology for the management of atrial fibrillation Chern-En Chiang, Tsu-Juey.

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2016 Guidelines of the Taiwan Heart Rhythm Society and the Taiwan Society of Cardiology for the management of atrial fibrillation Chern-En Chiang, Tsu-Juey Wu, Kwo-Chang Ueng, Tze-Fan Chao, Kuan-Cheng Chang, Chun-Chieh Wang, Yenn-Jiang Lin, Wei-Hsian Yin, Jen-Yuan Kuo, Wei-Shiang Lin, Chia-Ti Tsai, Yen-Bin Liu, Kun-Tai Lee, Li-Jen Lin, Lian-Yu Lin, Kang-Ling Wang, Yi-Jen Chen, Mien-Cheng Chen, Chen-Chuan Cheng, Ming-Shien Wen, Wen-Jone Chen, Jyh-Hong Chen, Wen-Ter Lai, Chuen-Wang Chiou, Jiunn- Lee Lin, San-Jou Yeh, Shih-Ann Chen Journal of the Formosan Medical Association Volume 115, Issue 11, Pages 893-952 (November 2016) DOI: 10.1016/j.jfma.2016.10.005 Copyright © 2016 Terms and Conditions

Figure 1 Prevalence rate of atrial fibrillation in Asian countries. Journal of the Formosan Medical Association 2016 115, 893-952DOI: (10.1016/j.jfma.2016.10.005) Copyright © 2016 Terms and Conditions

Figure 2 Overall management algorithm of atrial fibrillation. AF = atrial fibrillation; CV = cardioversion. Journal of the Formosan Medical Association 2016 115, 893-952DOI: (10.1016/j.jfma.2016.10.005) Copyright © 2016 Terms and Conditions

Figure 3 Annual risk of stroke in Taiwanese and Swedish. Journal of the Formosan Medical Association 2016 115, 893-952DOI: (10.1016/j.jfma.2016.10.005) Copyright © 2016 Terms and Conditions

Figure 4 The annual risk of stroke/systemic embolization events in Asians versus non-Asians under either warfarin or non-vitamin K antagonist oral anticoagulant treatment in four major clinical trials. A: RE-LY trial; B: ROCKET AF trial; C: ARISTOTLE trial; D: ENGAGE AF trial. (Modified from Chiang et al.95 with permission.) Journal of the Formosan Medical Association 2016 115, 893-952DOI: (10.1016/j.jfma.2016.10.005) Copyright © 2016 Terms and Conditions

Figure 5 International normalized ratios (INRs) in the randomized trials. Asians in RE-LY included patients from China, Japan, South Korea, Taiwan, Hong Kong, Philippines, Singapore, Malaysia, Thailand, and India.85 Asians in ROCKET included patients from China, South Korea, Taiwan, Hong Kong, Philippines, Singapore, Malaysia, and Thailand.330 Asians in ARISTOTLE included patients from China, Japan, South Korea, Taiwan, Hong Kong, Philippines, Singapore, and Malaysia.87 East Asians in ENGAGE included patients from China, Japan, South Korea, and Taiwan.88 Modified from Lip et al149 with permission. Journal of the Formosan Medical Association 2016 115, 893-952DOI: (10.1016/j.jfma.2016.10.005) Copyright © 2016 Terms and Conditions

Figure 6 Bleeding events on warfarin in Asians versus non-Asians, from the randomized trials. (A) Major bleeding; (B) intracranial hemorrhage; (C) gastrointestinal bleeding; (D) all (major plus minor) bleeding episodes. Modified from Lip et al149 with permission. Journal of the Formosan Medical Association 2016 115, 893-952DOI: (10.1016/j.jfma.2016.10.005) Copyright © 2016 Terms and Conditions

Figure 7 Major cardiovascular events on warfarin in Asians versus non-Asians, from the randomized trials. (A) Stroke and systemic embolization events; (B) ischemic stroke; (C) hemorrhagic stroke; (D) myocardial infarction; (E) all-cause death. Modified from Lip et al149 with permission. Journal of the Formosan Medical Association 2016 115, 893-952DOI: (10.1016/j.jfma.2016.10.005) Copyright © 2016 Terms and Conditions

Figure 8 Efficacy outcomes of (A) stroke or systemic embolism, (B) ischemic stroke, (C) myocardial infarction, and (D) all-cause mortality for the standard-dose non-vitamin K antagonist (VKA) oral anticoagulants (NOACs) versus VKAs. Modified from Wang et al150 with permission. CI = confidence interval; OR = odds ratio. Journal of the Formosan Medical Association 2016 115, 893-952DOI: (10.1016/j.jfma.2016.10.005) Copyright © 2016 Terms and Conditions

Figure 9 Safety outcomes of (A) major bleeding, (B) intracranial hemorrhage, (C) hemorrhagic stroke, and (D) gastrointestinal bleeding for the standard-dose non-vitamin K antagonist (VKA) oral anticoagulants (NOACs) versus VKAs. Modified from Wang et al150 with permission. CI = confidence interval; OR = odds ratio. Journal of the Formosan Medical Association 2016 115, 893-952DOI: (10.1016/j.jfma.2016.10.005) Copyright © 2016 Terms and Conditions

Figure 10 Efficacy outcomes of (A) stroke or systemic embolism, (B) ischemic stroke, (C) myocardial infarction, and (D) all-cause mortality for the low-dose non-vitamin K antagonist (VKA) oral anticoagulants (NOACs) versus VKAs. Modified from Wang et al150 with permission. CI = confidence interval; OR = odds ratio. Journal of the Formosan Medical Association 2016 115, 893-952DOI: (10.1016/j.jfma.2016.10.005) Copyright © 2016 Terms and Conditions

Figure 11 Safety outcomes of (A) major bleeding, (B) intracranial hemorrhage, (C) hemorrhagic stroke, and (D) gastrointestinal bleeding for the low-dose non-vitamin K antagonist (VKA) oral anticoagulants (NOACs) versus VKAs. Modified from Wang et al150 with permission. CI = confidence interval; OR = odds ratio. Journal of the Formosan Medical Association 2016 115, 893-952DOI: (10.1016/j.jfma.2016.10.005) Copyright © 2016 Terms and Conditions

Figure 12 Rationale for using CHA2DS2-VASc score = 1 for threshold of using non-vitamin K antagonist oral anticoagulants in Asians. ICH = intracranial hemorrhage. Journal of the Formosan Medical Association 2016 115, 893-952DOI: (10.1016/j.jfma.2016.10.005) Copyright © 2016 Terms and Conditions

Figure 13 Management algorithm for stroke prevention in Asians. AF = atrial fibrillation; NOAC = non-vitamin K antagonist oral anticoagulant. (Modified from Lip et al.149 with permission.) Journal of the Formosan Medical Association 2016 115, 893-952DOI: (10.1016/j.jfma.2016.10.005) Copyright © 2016 Terms and Conditions

Figure 14 Switching algorithm of anticoagulants. DC = discontinue; eGFR = estimated glomerular filtration rate (mL/min/1.73 m2); INR = international normalized ratio; LMWH = low molecular weight heparin; NOAC = non-vitamin K antagonist oral anticoagulant; UFH = unfractionated heparin. Journal of the Formosan Medical Association 2016 115, 893-952DOI: (10.1016/j.jfma.2016.10.005) Copyright © 2016 Terms and Conditions

Figure 15 Cardiovascular outcomes of randomized controlled trials of comparing rhythm- versus rate-control strategies. Journal of the Formosan Medical Association 2016 115, 893-952DOI: (10.1016/j.jfma.2016.10.005) Copyright © 2016 Terms and Conditions

Figure 16 Choice of drugs for chronic rate control. COPD = chronic obstructive pulmonary disease. Journal of the Formosan Medical Association 2016 115, 893-952DOI: (10.1016/j.jfma.2016.10.005) Copyright © 2016 Terms and Conditions

Figure 17 Flow chart of chronic rate control. HR = heart rate (beats/min, bpm). Journal of the Formosan Medical Association 2016 115, 893-952DOI: (10.1016/j.jfma.2016.10.005) Copyright © 2016 Terms and Conditions

Figure 18 Management algorithm of electrical cardioversion. AF = atrial fibrillation; LA = left atrium; LAA = left atrial appendage; OAC = oral anticoagulant; TEE = transesophageal echocardiography. Journal of the Formosan Medical Association 2016 115, 893-952DOI: (10.1016/j.jfma.2016.10.005) Copyright © 2016 Terms and Conditions

Figure 19 Flow chart of the selection of the rhythm control drugs. CAD = coronary artery disease; HT = hypertension; LVH = left ventricular hypertrophy. (Modified from Chiang et al.31 with permission.) Journal of the Formosan Medical Association 2016 115, 893-952DOI: (10.1016/j.jfma.2016.10.005) Copyright © 2016 Terms and Conditions