The New Atrial Fibrillation Guidelines

Interview With Mina Chung, MD

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In this interview from Western AF 2024, we speak with Mina Chung, MD, from the Cleveland Clinic about the 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation (AF). 

What will you be discussing today? Tell us about your presentation at Western AF.

Today, I went over the top 10 highlights of the ACC/AHA/ACCP/HRS AF management guidelines. We went over some of the highlights, which include a new staging system of AF that includes 2 stages before the diagnosis of AF, allowing us to focus on a stage at which patients may be at risk for AF because they have reversible or non-reversible risk factors for AF. Then there is a pre-AF stage, in which they may manifest some structural or electrical abnormalities that predispose to AF. Once AF becomes manifest, then there is the usual paroxysmal, persistent, long-standing persistent, and permanent AF, as well as a 3D stage for successfully ablated AF. So, this staging system allows us to have a focus on the pre-AF stage that allows us to focus on lifestyle and risk factor modification, and then also emphasizes the progressive nature of AF. We also went over lifestyle risk factor modification (LRFM), which I hope will become an acronym as common as GDMT (guideline-directed medical therapy) for heart failure. We talked about the class I recommendations for targeting lifestyle and risk factors for AF, for both primary and secondary prevention. We also went over some of the new recommendations for anticoagulation and prevention of stroke and thromboembolism, as well as some new recommendations on left atrial appendage occlusion. There was a lot of discussion on the oral anticoagulants. We also went over a focus of the guideline on early rhythm control, as well as some recommendations for AF ablation, which achieved a class 1 recommendation for first-line therapy in selected patients, as well as some 2a and 2b recommendations for patients, for example, who may be asymptomatic or minimally symptomatic, but that it may in select patients be able to prevent progression of AF. 

Discuss the potential impact of the new AF guidelines on clinical practice. 

We hope that the guideline will be very helpful to practitioners who are taking care of patients with AF or who may be at risk for AF. We tried to make the guideline and the recommendations very evidence-based and hopefully practical, comprehensive, and helpful. There are a lot of tables and figures besides the recommendations that we hope will help people take care of patients.

What are the take-home messages you would like viewers to leave with? 

Hopefully, when people read the guideline, they will find areas where they can change practice in or add to their practice for patients with AF. The guideline was really a new guideline. It wasn't an update of an older AF management guideline or a focused update. We started from ground zero and we welcome any input. We hope that it will be a living guideline, so that we can modify it in the future as new data and science emerge. 

How does attending Western AF help improve patient care?

The education that we're getting here and the comprehensive view of everything having to do with AF is fantastic. Hopefully, we'll bring this back to our clinics and really help our patients with the most up-to-date treatments that are available for AF.

The transcripts have been edited for clarity and length.