Department of Cardiology, Memorial Ankara Hospital, Memorial Healthcare Group, Ankara, Turkey.
Department of Cardiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.
Cardiology. 2022;147(1):81-89. doi: 10.1159/000519465. Epub 2021 Sep 21.
Guidelines for the diagnosis and management of atrial fibrillation (AF) are frequently published and updated, reflecting the rapid evolution in AF pathogenesis and treatment modalities.
Recently, 2 important guidelines for the diagnosis and management of atrial AF have been published by the European Society of Cardiology (ESC), and Canadian Cardiovascular Society (CCS). Although the evidence-based recommendations and statements are quite similar, there are some important differences between the ESC and CCS guidelines for AF. Herein, we compared the current recommendations and highlighted the differences from the most recent guidelines for AF. Key Messages: Specifically, key differences can be observed in methods evaluating the recommendations; classifications and the definitions; the symptom score used to guide management decisions, longitudinal patient assessment, and structured characterization; the stroke risk stratification algorithm used to determine indications for oral anticoagulation therapy; the role of acetylsalicylic acid in stroke prevention in AF; the antithrombotic regimens that are employed in the setting of chronic coronary syndromes, acute coronary syndromes, and percutaneous coronary intervention; the target heart rate for rate control; and the algorithms for integrated or holistic management of AF. Differences are observed, particularly when the quality of evidence is moderate or low. More research and randomized controlled studies on major gaps identified in current guidelines will further clarify and modify our future management strategies in AF.
心房颤动（AF）的诊断和管理指南经常发布和更新，反映了 AF 发病机制和治疗方式的快速演变。
最近，欧洲心脏病学会（ESC）和加拿大心血管学会（CCS）发布了 2 项重要的心房颤动诊断和管理指南。尽管基于证据的建议和声明非常相似，但 ESC 和 CCS 关于 AF 的指南之间存在一些重要差异。在此，我们比较了目前的建议，并强调了与最近 AF 指南的差异。要点：具体而言，可以在评估建议的方法；分类和定义；用于指导管理决策、纵向患者评估和结构化描述的症状评分；用于确定口服抗凝治疗适应证的卒中风险分层算法；AF 中阿司匹林在卒中预防中的作用；在慢性冠状动脉综合征、急性冠状动脉综合征和经皮冠状动脉介入治疗中使用的抗血栓治疗方案；用于控制心率的目标心率；以及 AF 的综合或整体管理算法方面观察到关键差异。当证据质量为中等或低等时，观察到的差异尤其明显。对当前指南中确定的主要空白领域进行更多的研究和随机对照研究，将进一步阐明和修改我们未来在 AF 中的管理策略。
