© 2006 by the American College of Cardiology Foundation, the American Heart Association, Inc, and the European Society of Cardiology. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation–executive summary
A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society
Authors/Task Force Members,
ESC Committee for Practice Guidelines,
France
Poland
United Kingdom
France
The Netherlands
France
Norway
Greece
France
Italy
Portugal
Germany
Spain
Spain
ACC/AHA (Practice Guidelines) Task Force Members,
Key Words: ACC/AHA/ESC Guidelines • atrial fibrillation • arrhythmia • heart rate • anticoagulants • antiarrhythmia agents • electrophysiology • pharmacology
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Preamble |
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It is important that the medical profession play a significant role in critically evaluating the use of diagnostic procedures and therapies as they are introduced and tested in the detection, management, or prevention of disease states. Rigorous and expert analysis of the available data documenting absolute and relative benefits and risks of those procedures and therapies can produce helpful guidelines that improve the effectiveness of care, optimize patient outcomes, and favorably affect the overall cost of care by focusing resources on the most effective strategies.
The American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) have jointly engaged in the production of such guidelines in the area of cardiovascular disease since 1980. The ACC/AHA Task Force on Practice Guidelines, whose charge is to develop, update, or revise practice guidelines for important cardiovascular diseases and procedures, directs this effort. The Task Force is pleased to have this guideline
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I. Introduction |
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A. Organization of committee and evidence review
Classification of recommendations
Level of evidence
B. Changes since the initial publication of these guidelines in 2001
C. Recommendations for management of patients with atrial fibrillation
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Recommendations |
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1. Pharmacological rate control during atrial fibrillation
2. Preventing thromboembolism
3. Cardioversion of atrial fibrillation
a. Pharmacological cardioversion
b. Direct-current cardioversion
c. Pharmacological enhancement of direct-current cardioversion
d. Prevention of thromboembolism in patients with atrial fibrillation undergoing cardioversion
4. Maintenance of sinus rhythm
5. Special considerations
a. Postoperative atrial fibrillation
b. Acute myocardial infarction
c. Management of atrial fibrillation associated with the Wolff-Parkinson-White (WPW) preexcitation syndrome
d. Hyperthyroidism
e. Management of atrial fibrillation during pregnancy
f. Management of atrial fibrillation in patients with hypertrophic cardiomyopathy (HCM)
g. Management of atrial fibrillation in patients with pulmonary disease
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II. Definition |
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A. Atrial fibrillation
B. Related arrhythmias
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III. Classification |
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IV. Epidemiology and prognosis |
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A. Prevalence
B. Incidence
C. Prognosis
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V. Pathophysiological mechanisms |
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A. Atrial factors
1. Atrial pathology as a cause of atrial fibrillation
2. Mechanisms of atrial fibrillation
3. Atrial electrical remodeling
4. Other factors contributing to atrial fibrillation
B. Atrioventricular conduction
1. General aspects
2. Atrioventricular conduction in preexcitation syndromes
C. Myocardial and hemodynamic consequences of atrial fibrillation
D. Thromboembolism
1. Pathophysiology of thrombus formation
2. Clinical implications
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VI. Causes, associated conditions, clinical manifestations, and quality of life |
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A. Causes and associated conditions
1. Reversible causes of atrial fibrillation
2. Atrial fibrillation without associated heart disease
3. Medical conditions associated with atrial fibrillation
4. Atrial fibrillation with associated heart disease
5. Familial atrial fibrillation
6. Autonomic influences in atrial fibrillation
B. Clinical manifestations
C. Quality of life
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VII. Clinical evaluation |
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A. Basic evaluation of the patient with atrial fibrillation
1. Clinical history and physical examination
2. Investigations
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VIII. Management |
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A. Strategic objectives
B. Pharmacological and nonpharmacological treatment options
1. Heart rate control versus rhythm control
a. Pharmacological rate control during atrial fibrillation
b. Regulation of atrioventricular nodal conduction by pacing
c. Atrioventricular nodal ablation
2. Preventing thromboembolism
a. Risk stratification
b. Antithrombotic strategies for prevention of ischemic stroke and systemic embolism
c. Nonpharmacological approaches to prevention of thromboembolism
3. Cardioversion of atrial fibrillation
a. Pharmacological cardioversion
4. Pharmacological agents to maintain sinus rhythm
a. Agents with proven efficacy to maintain sinus rhythm
b. Out-of-hospital initiation of antiarrhythmic drugs in patients with atrial fibrillation
5. Direct-current cardioversion of atrial fibrillation and atrial flutter
a. Technical and procedural aspects
b. Risks and complications of direct-current cardioversion of atrial fibrillation
c. Pharmacological enhancement of direct-current cardioversion
d. Prevention of thromboembolism in patients with atrial fibrillation undergoing conversion
6. Maintenance of sinus rhythm
a. Pharmacological therapy
b. Predictors of recurrent atrial fibrillation
c. General approach to antiarrhythmic drug therapy
d. Selection of antiarrhythmic agents in patients with cardiac diseases
7. Nonpharmacological therapy for atrial fibrillation
a. Surgical ablation
b. Catheter ablation
c. Suppression of atrial fibrillation through pacing
d. Internal atrial defibrillators
C. Primary prevention
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IX. Proposed management strategies |
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A. Overview of algorithms for management of patients with atrial fibrillation
1. Newly discovered atrial fibrillation
2. Recurrent paroxysmal atrial fibrillation
3. Recurrent persistent atrial fibrillation
4. Permanent atrial fibrillation
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