Spotlight on the 2024 ESC/EACTS management of atrial fibrillation guidelines: 10 novel key aspects

Michiel Rienstra¹, Stylianos Tzeis², Karina V Bunting³, Valeria Caso⁴, Harry J G M Crijns^{5

6}, Tom J R De Potter⁷, Prashanthan Sanders⁸, Emma Svennberg⁹, Ruben Casado-Arroyo¹⁰, Jeremy Dwight¹¹, Luigina Guasti^{12

13}, Thorsten Hanke¹⁴, Tiny Jaarsma^{15

16}, Maddalena Lettino¹⁷, Maja-Lisa Løchen^{18

19}, R Thomas Lumbers^{20

21

22}, Bart Maesen^{23

24}, Inge Mølgaard¹¹, Giuseppe M C Rosano^{25

26

27}, Renate B Schnabel^{28

29}, Piotr Suwalski³⁰, Juan Tamargo³¹, Otilia Tica^{3

32}, Vassil Traykov³³, Dipak Kotecha^{3

34}, Isabelle C Van Gelder¹

Affiliations

¹ Department of Cardiology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
² Department of Cardiology, Mitera Hospital, Athens, Greece.
³ Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
⁴ Stroke Unit, Santa Maria della Misericordia-University of Perugia, Perugia, Italy.
⁵ Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.
⁶ Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
⁷ Department of Cardiology, OLV Hospital, Aalst, Belgium.
⁸ Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia.
⁹ Department of Medicine Karolinska University Hospital (MedH), Karolinska Institutet, Stockholm, Sweden.
¹⁰ Department of Cardiology, H.U.B.-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
¹¹ ESC Patient Forum, Sophia Antipolis, France.
¹² Department of Medicine and Surgery, University of Insubria, Varese, Italy.
¹³ Division of Geriatrics and Clinical Gerontology, ASST-Settelaghi, Varese, Italy.
¹⁴ Clinic For Cardiac Surgery, Asklepios Klinikum, Harburg, Hamburg, Germany.
¹⁵ Department of Cardiology, Linkoping University, Linkoping, Sweden.
¹⁶ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
¹⁷ Department for Cardiac, Thoracic and Vascular Diseases, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
¹⁸ Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway.
¹⁹ Department of Cardiology, University Hospital of North Norway, Tromsø, Norway.
²⁰ Institute of Health Informatics, University College London, London, UK.
²¹ Saint Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
²² University College Hospital, University College London Hospitals NHS Trust, London, UK.
²³ Department of Cardiothoracic Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands.
²⁴ Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
²⁵ Department of Human Sciences and Promotion of Quality of Life, Chair of Pharmacology, San Raffaele University of Rome, Rome, Italy.
²⁶ Department of Cardiology, San Raffaele Cassino Hospital, Cassino, Italy.
²⁷ Cardiovascular Academic Group, St George's University Medical School, London, UK.
²⁸ Cardiology University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
²⁹ German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck, Germany.
³⁰ Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland.
³¹ Pharmacology and Toxicology School of Medicine, Universidad Complutense, Madrid, Spain.
³² Department of Cardiology, Emergency County Clinical Hospital of Bihor, Oradea, Romania.
³³ Department of Invasive Electrophysiology, Acibadem City Clinic Tokuda University Hospital, Sofia, Bulgaria.
³⁴ NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.

PMID: 39716733
PMCID: PMC11666470
DOI: 10.1093/europace/euae298

Review

Spotlight on the 2024 ESC/EACTS management of atrial fibrillation guidelines: 10 novel key aspects

Michiel Rienstra et al. Europace. 2024.

. 2024 Dec 3;26(12):euae298.

doi: 10.1093/europace/euae298.

Authors

Affiliations

¹ Department of Cardiology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
² Department of Cardiology, Mitera Hospital, Athens, Greece.
³ Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
⁴ Stroke Unit, Santa Maria della Misericordia-University of Perugia, Perugia, Italy.
⁵ Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.
⁶ Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
⁷ Department of Cardiology, OLV Hospital, Aalst, Belgium.
⁸ Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia.
⁹ Department of Medicine Karolinska University Hospital (MedH), Karolinska Institutet, Stockholm, Sweden.
¹⁰ Department of Cardiology, H.U.B.-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
¹¹ ESC Patient Forum, Sophia Antipolis, France.
¹² Department of Medicine and Surgery, University of Insubria, Varese, Italy.
¹³ Division of Geriatrics and Clinical Gerontology, ASST-Settelaghi, Varese, Italy.
¹⁴ Clinic For Cardiac Surgery, Asklepios Klinikum, Harburg, Hamburg, Germany.
¹⁵ Department of Cardiology, Linkoping University, Linkoping, Sweden.
¹⁶ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
¹⁷ Department for Cardiac, Thoracic and Vascular Diseases, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
¹⁸ Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway.
¹⁹ Department of Cardiology, University Hospital of North Norway, Tromsø, Norway.
²⁰ Institute of Health Informatics, University College London, London, UK.
²¹ Saint Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
²² University College Hospital, University College London Hospitals NHS Trust, London, UK.
²³ Department of Cardiothoracic Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands.
²⁴ Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
²⁵ Department of Human Sciences and Promotion of Quality of Life, Chair of Pharmacology, San Raffaele University of Rome, Rome, Italy.
²⁶ Department of Cardiology, San Raffaele Cassino Hospital, Cassino, Italy.
²⁷ Cardiovascular Academic Group, St George's University Medical School, London, UK.
²⁸ Cardiology University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
²⁹ German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck, Germany.
³⁰ Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland.
³¹ Pharmacology and Toxicology School of Medicine, Universidad Complutense, Madrid, Spain.
³² Department of Cardiology, Emergency County Clinical Hospital of Bihor, Oradea, Romania.
³³ Department of Invasive Electrophysiology, Acibadem City Clinic Tokuda University Hospital, Sofia, Bulgaria.
³⁴ NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.

PMID: 39716733
PMCID: PMC11666470
DOI: 10.1093/europace/euae298

Abstract

Atrial fibrillation (AF) remains the most common cardiac arrhythmia worldwide and is associated with significant morbidity and mortality. The European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (EACTS) have recently released the 2024 guidelines for the management of AF. This review highlights 10 novel aspects of the ESC/EACTS 2024 Guidelines. The AF-CARE framework is introduced, a structural approach that aims to improve patient care and outcomes, comprising of four pillars: [C] Comorbidity and risk factor management, [A] Avoid stroke and thromboembolism, [R] Reduce symptoms by rate and rhythm control, and [E] Evaluation and dynamic reassessment. Additionally, graphical patient pathways are provided to enhance clinical application. A significant shift is the new emphasis on comorbidity and risk factor control to reduce AF recurrence and progression. Individualized assessment of risk is suggested to guide the initiation of oral anticoagulation to prevent thromboembolism. New guidance is provided for anticoagulation in patients with trigger-induced and device-detected sub-clinical AF, ischaemic stroke despite anticoagulation, and the indications for percutaneous/surgical left atrial appendage exclusion. AF ablation is a first-line rhythm control option for suitable patients with paroxysmal AF, and in specific patients, rhythm control can improve prognosis. The AF duration threshold for early cardioversion was reduced from 48 to 24 h, and a wait-and-see approach for spontaneous conversion is advised to promote patient safety. Lastly, strong emphasis is given to optimize the implementation of AF guidelines in daily practice using a patient-centred, multidisciplinary and shared-care approach, with the simultaneous launch of a patient version of the guideline.

Keywords: Atrial fibrillation; Guidelines; Management.

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Conflict of interest statement

Conflict of interest: All authors and collaborators have participated in the 2024 European Society of Cardiology/European Association for Cardio-Thoracic Surgery Guideline on Atrial Fibrillation Task force and have submitted declarations of interest which are reported in a supplementary document to the guidelines.

Figures

**Graphical Abstract**
Overview of 10 novel key points in the 2024 ESC/EACTS Guidelines on the management of atrial fibrillation. AF, atrial fibrillation; LAA, left atrial appendage; OAC, oral anticoagulant; pAF, paroxysmal atrial fibrillation.

**Figure 1**
AF-CARE framework. AF, atrial fibrillation; CARE, [C] Comorbidity and risk factor management, [A] Avoid stroke and thromboembolism, [R] Reduce symptoms by rate and rhythm control, [E] Evaluation and dynamic reassessment. Adapted from EHJ 2024.

See this image and copyright information in PMC

References

1. Cheng S, He J, Han Y, Han S, Li P, Liao H et al. Global burden of atrial fibrillation/atrial flutter and its attributable risk factors from 1990 to 2021. Europace 2024;26:euae195. - PMC - PubMed
1. Walli-Attaei M, Little M, Luengo-Fernandez R, Gray A, Torbica A, Maggioni AP et al. Health-related quality of life and healthcare costs of symptoms and cardiovascular disease events in patients with atrial fibrillation: a longitudinal analysis of 27 countries from the EURObservational Research Programme on Atrial Fibrillation general long-term registry. Europace 2024;26:euae146. - PMC - PubMed
1. Mobley AR, Subramanian A, Champsi A, Wang X, Myles P, McGreavy P et al. Thromboembolic events and vascular dementia in patients with atrial fibrillation and low apparent stroke risk. Nat Med 2024;30:2288–94. - PMC - PubMed
1. Van Gelder IC, Rienstra M, Bunting KV, Casado-Arroyo R, Caso V, Crijns HJGM et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2024;45:3314–414. - PubMed
1. Brandes A, Pedersen SS, Hendriks JM. A call for action to include psychosocial management into holistic, integrated care for patients with atrial fibrillation. Europace 2024;26:euae078. - PMC - PubMed

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Spotlight on the 2024 ESC/EACTS management of atrial fibrillation guidelines: 10 novel key aspects

Affiliations

Spotlight on the 2024 ESC/EACTS management of atrial fibrillation guidelines: 10 novel key aspects

Authors

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Abstract

Conflict of interest statement

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