Guideline for procedures in patients with atrial fibrillation

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, occurring in 1–2% of the general population. Over 6 million Europeans suffer from this arrhythmia, and its prevalence is estimated to at least double in the next 50 years as the population ages. It is now 4 years since the last AF guideline was published, and a new version is now needed. AF confers a 5-fold risk of stroke, and one in five of all strokes is attributed to this arrhythmia. Ischaemic strokes in association with AF are often fatal, and those patients who survive are left more disabled by their stroke and more likely to suffer a recurrence than patients with other causes of stroke. In consequence, the risk of death from AF-related stroke is doubled and the cost of care is increased 1.5-fold. There has been much research into stroke prevention, which has influenced this guideline. In the majority of patients there appears to be an inexorable progression of AF to persistent or permanent forms, associated with further development of the disease that may underlie the arrhythmia. Some advance has been made in the understanding of the dynamic development of AF from its preclinical state as an ‘arrhythmia-in-waiting’ to its final expression as an irreversible and end-stage cardiac arrhythmia associated with serious adverse cardiovascular events. Much recent therapeutic effort with ‘upstream therapies’ has been expended to slow or halt the progression of AF due to underlying cardiovascular disease and to AF itself. Limited success has been achieved and is recognized in this guideline.