2014 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation Atul Verma, MD, John A. Cairns, MD, L.

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2014 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation Atul Verma, MD, John A. Cairns, MD, L. Brent Mitchell, MD, Laurent Macle, MD, Ian G. Stiell, MD, David Gladstone, MD, Michael Sean McMurtry, MD, Stuart Connolly, MD, Jafna L. Cox, MD, Paul Dorian, MD, Noah Ivers, MD, Kori Leblanc, PharmD, Stanley Nattel, MD, Jeff S. Healey, MD Canadian Journal of Cardiology Volume 30, Issue 10, Pages 1114-1130 (October 2014) DOI: 10.1016/j.cjca.2014.08.001 Copyright © 2014 Canadian Cardiovascular Society Terms and Conditions

Figure 1 The simplified “CCS algorithm” for deciding which patients with atrial fibrillation (AF) or atrial flutter (AFL) should receive oral anticoagulation (OAC) therapy. * We suggest that a NOAC be used in preference to warfarin for non-valvular AF. † Might require lower dosing. ASA, acetylsalicylic acid; CAD, coronary artery disease; CCS, Canadian Cardiovascular Society; CHADS2, Congestive Heart Failure, Hypertension, Age, Diabetes, Stroke/Transient Ischemic Attack; eGFR, estimated glomerular filtration rate; INR, international normalized ratio; NOAC, novel oral anticoagulant; NSAID, nonsteroidal anti-inflammatory drug; TIA, transient ischemic attack. Canadian Journal of Cardiology 2014 30, 1114-1130DOI: (10.1016/j.cjca.2014.08.001) Copyright © 2014 Canadian Cardiovascular Society Terms and Conditions

Figure 2 Decision algorithm for management of oral anticoagulation (OAC) therapy for patients who present to the emergency department (ED) with recent-onset atrial fibrillation (AF) requiring rate control or cardioversion (CV) in the ED. † Immediate OAC = a dose of OAC should be given just before cardioversion; either a novel direct oral anticoagulant (NOAC) or a dose of heparin or low molecular weight heparin with bridging to warfarin if a NOAC is contraindicated. ASA, acetylsalicylic acid; CAD, coronary artery disease; CHADS2, Congestive Heart Failure, Hypertension, Age, Diabetes, Stroke/Transient Ischemic Attack; TIA, transient ischemic attack. Canadian Journal of Cardiology 2014 30, 1114-1130DOI: (10.1016/j.cjca.2014.08.001) Copyright © 2014 Canadian Cardiovascular Society Terms and Conditions

Figure 3 Approach to rate and/or rhythm control of atrial fibrillation (AF) in patients presenting with symptomatic AF. QOL, quality of life. Canadian Journal of Cardiology 2014 30, 1114-1130DOI: (10.1016/j.cjca.2014.08.001) Copyright © 2014 Canadian Cardiovascular Society Terms and Conditions