1. C. ACC/AHA/ESC guidelines Role of anticoagulant therapy in AF
ACC/AHA/ESC guidelines for AF management: Newly discovered AF
Content Points:
The American College of Cardiology (ACC), the American Heart Association (AHA), and the European Society of Cardiology (ESC) jointly issued a set of recommendations on evaluation and management of patients with AF.1 The guidelines were developed in collaboration with the North American Society of Pacing and Electrophysiology.
The slide shows a suggested algorithm for management of patients with newly discovered AF.
Recognizing that it is not always clear if the initial presentation is, in fact, the patient's first episode, the guidelines committee consider that antiarrhythmic drugs are usually unnecessary in patients who have self-limiting episodes of paroxysmal AF. Exception can be made in the case of severe symptoms related to hypotension, heart failure, or angina.
- The decision to proceed with anticoagulant therapy can be based on the individual patient's level of risk for thromboembolic events.
In patients with persistent AF, the guidelines committee state that an attempt to restore sinus rhythm is reasonable but may not be in the best interest of all patients. An alternative strategy is to accept progression to permanent AF, with attention to anticoagulant therapy.
1Fuster V, Rydén LE, Asinger RW, Cannom DS, Crijns HJ, Frye RL, et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force of Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients with Atrial Fibrillation). J Am Coll Cardiol. 2001;38:

2. ACC/AHA/ESC guidelines for AF management: Recurrent paroxysmal AF
Content Points:
The slide shows a suggested algorithm for management of patients with recurrent paroxysmal AF.1
In patients with symptoms that are brief in duration or of minimal severity, it is reasonable to avoid antiarrhythmic drugs. Disabling symptoms generally call for such therapy, however.
In either case, anticoagulation is appropriate.
1Fuster V, Rydén LE, Asinger RW, Cannom DS, Crijns HJ, Frye RL, et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force of Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients with Atrial Fibrillation). J Am Coll Cardiol. 2001;38:

3. ACC/AHA/ESC guidelines for AF management: Recurrent persistent and permanent AF
Content Points:
The slide shows suggested algorithms for management of patients with recurrent persistent AF or permanent AF.1
Recurrent persistent AF: For patients with minimal symptoms who have undergone at least one attempt to restore sinus rhythm, rate control and anticoagulant therapy are recommended. If symptoms are disabling, antiarrhythmic therapy should be added.
Permanent AF: When cardioversion cannot be sustained, the guidelines still recommend rate control and anticoagulation.
1Fuster V, Rydén LE, Asinger RW, Cannom DS, Crijns HJ, Frye RL, et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force of Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients with Atrial Fibrillation). J Am Coll Cardiol. 2001;38: