The International Academy of Cardiology is dedicated to the advancement of global research in cardiovascular medicine through the support of scientific meetings and publications.
Michael E. Cain, M.D., University at Buffalo, Buffalo, NY, USA
The 2014 AHA/ACC/HRS Guidelines for the management of patients with atrial fibrillation (AF) are derived from published clinical trials, basic science, and comprehensive review articles. They supersede the ACC/AHA/ESC 2006 Guidelines and two subsequent focused updates from 2011. Key new recommendations impacting patient care are: 1) usage (Class I) of the CHA2DS2-VASc score to assess risk of stroke in patients with nonvalvular AF; 2) usage (Class I) of oral anticoagulation (warfarin, dabigatran, rivaoxaban, or apixaban) for patients with nonvalvular AF with a history of stroke, transient ischemic attack, or a CHA2DS2-VASc score of 2 or greater; 3) omission (Class IIa) of antithrombotic therapy for patients with nonvalvular AF and a CHA2DS2-VASc score of 0; 4) for patients with nonvalvular AF and a CHA2DS2-VASc score of 1, choice (Class IIb) of no antithrombotic therapy, oral anticoagulation, or aspirin; 5) avoidance (Class III harm) of dabigatran, rivaroxaban, or apixaban for patients with AF and a mechanical or bioprosthetic heart valve; 6) avoidance of flecainide, propafenone, dofetilide, and sotalol in patients with severe left ventricular hypertrophy and AF; 7) prescription (Class I) of oral anticoagulation for patients with hypertrophic cardiomyopathy and AF irrespective of CHA2DS2-VASc score; 8) catheter ablation is useful (Class I) for patients with symptomatic, paroxysmal, AF who have not responded to or tolerated antiarrhythmic medications; and 9) catheter ablation is reasonable (Class II) in selected patients with symptomatic, paroxysmal, AF prior to a trial of medical therapy, provided it can be performed at an experienced center.
