Atrial fibrillation – key recommendations

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in adults. Its occurrence often results in reduced quality of life for patients. To make the diagnosis of AF, documentation of its presence on the ECG is required (heart rhythm with no apparent repetitive P-waves and irregular RR intervals). It may also be helpful to identify episodes of rapid atrial rhythms (AHRE), especially if they occur frequently and are of long duration (in patients with implanted cardiac monitoring devices).

A risk-factor approach using the CHA2DS2-VASc Stroke Risk Scale is recommended for stroke risk assessment. In addition to assessing thrombotic risk, an assessment of bleeding risk using the HAS-BLED scale is recommended. Patients with AF and stroke risk factors should be treated with oral anticoagulants (OACs) for stroke prevention. In patients eligible for OACs, NOACs are preferred over VKAs.

Pharmacological control of the ventricular rate in AF can be achieved by using various groups of drugs, including beta-blockers, non-dihydropyridine calcium channel antagonists, and digoxin.

In the case of pharmacological cardioversion, the choice of a particular drug depends on the type and concomitant heart disease.

The severity of cardiovascular risk factors and comorbidities, including lifestyle factors, significantly affects the risk of developing AF.