The 2020 ESC Guidelines on the Diagnosis and Management of Atrial Fibrillation

AF has major clinical implications on patients’ quality of life, morbidity with ischaemic stroke and heart failure, and mortality when compared with the general population.1 AF is the most common sustained arrhythmia and it has been calculated that it will affect 17.9 million adults in the EU and the UK by 2060.2 The increasing prevalence of AF is driven mainly by the ageing population and the high burden of risk factors and comorbidities, which raises significant issues about the use of healthcare systems and economic costs.2–4 The 2020 European Society of Cardiology (ESC) Clinical Practice Guidelines for AF summarise and evaluate the available evidence from 1,492 references to provide an overview of contemporary AF diagnosis, management and research.3 Given the complexity of AF and its poorly understood mechanisms, the management of AF patients requires a holistic, multidisciplinary approach, including individual assessment, patient preferences and active involvement in decision-making. The guidelines introduce a novel, simplified, holistic approach to care for patients with AF (Figure 1), incorporating screening, diagnosis and treatment for effective, integrated management.3 These AF guidelines should consider the clinical evaluation and the choice of the best treatment strategies for each individual patient with AF.3 To accompany the guidelines, the ESC published quality indicators (17 main and 17 secondary indicators from six domains of care) to help improve and allow comparisons of the overall quality of care among AF patients at various levels, by looking at data at patient, centre or international level.3,5 Detection of AF In recent years, substantial progress has been made in detecting AF, including asymptomatic AF. Better Symptom Control Rate control allows AF to persist with well-controlled ventricular rates whereas rhythm control strategy involves the restoration of sinus rhythm using ablation, cardioversion or anti-arrhythmic drugs to mitigate AF symptoms and improve quality of life.3 Rhythm control may improve overall clinical outcomes compared with rate control in selected patient groups, for example those with heart failure or where AF has been recently diagnosed.22,23 Indeed, improvements in existing ablation techniques and tools have increased the efficacy and safety of catheter AF ablation. Subsequently, treatment of specific cardiovascular risks, such as hypertension, heart failure and coronary artery disease, and non-cardiovascular con