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Current Management of Atrial Fibrillation in Routine Practice According to Last Esc Guidelines: An Ehra Physician Survey. How are we dealing with controversial approaches?

Guerra, Jose M; Moreno Weidmann, Zoraida; Perrotta, Laura; Sultan, Arian; Anic, Ante; Metzner, Andreas; Providencia, Rui; (2024) Current Management of Atrial Fibrillation in Routine Practice According to Last Esc Guidelines: An Ehra Physician Survey. How are we dealing with controversial approaches? EP Europace , 26 (2) , Article euae012. 10.1093/europace/euae012. Green open access

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Abstract

BACKGROUND AND AIMS: Although guidelines for the management of atrial fibrillation (AF) are regularly published, many controversial issues remain, limiting their implementation. We aim to describe current clinical practice among European Heart Rhythm (EHRA) community according to last guidelines. METHODS: A 30 multiple-choice questionnaire covering the most controversial topics related to AF management was distributed through the EHRA Research Network, National Societies and social media between January and February 2023. RESULTS: 181 physicians responded the survey, 61% from university hospitals. AF screening in high-risk patients is regularly performed by 57%. Only 42% has access to at least one program aiming at diagnosing/managing comorbidities and lifestyle modifications, with marked heterogeneity between countries. Direct oral anticoagulants are the preferred antithrombotic (97%). Rhythm control is the preferred strategy in most AF phenotypes: symptomatic vs asymptomatic paroxysmal AF (97% vs 77%), low vs high risk for recurrence persistent AF (90% vs 72%), permanent AF (20%). I-C drugs and amiodarone are preferred while dronedarone and sotalol barely used. Ablation is the first-line therapy for symptomatic paroxysmal AF (69%) and persistent AF with markers of atrial disease (57%) and is performed independently of symptoms by 15%. In persistent AF, 68% performs only pulmonary vein isolation and 32% also additional lesions. CONCLUSION: There is marked heterogeneity in AF management and limited accordance to last guidelines in the EHRA community. Most of the discrepancies are related to the main controversial issues, such as those related to AF screening, management of comorbidities, pharmacological treatment, and ablation strategy.

Type: Article
Title: Current Management of Atrial Fibrillation in Routine Practice According to Last Esc Guidelines: An Ehra Physician Survey. How are we dealing with controversial approaches?
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/europace/euae012
Publisher version: http://dx.doi.org/10.1093/europace/euae012
Language: English
Additional information: Copyright © The Author(s) 2024. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Atrial fibrillation, ablation, antiarrhythmic treatment, anticoagulation, clinical practice, comorbidities, guidelines
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics
URI: https://discovery.ucl.ac.uk/id/eprint/10186336
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