The Year in Cardiovascularmedicine 2020: Arrhythmias

Harry J.G.M. Crijns; Frits Prinzen; Pier D. Lambiase; Prashanthan Sanders; Josep Brugada


Eur Heart J. 2021;42(5):499-507. 

In This Article

New Guidelines

The guidelines on supraventricular tachycardia (SVT) and AF brought many new insights and recommendations.[1,2] The former dealt with SVT ablation as an early strategy and invasive risk assessment in ventricular preexcitation. Its focus also was on what-to-avoid in management of SVT.[2] The new guidelines on AF promote the slogan 'CC to ABC', indicating that electrical Confirmation of AF is mandatory together with in-depth Characterisation of AF (Figure 1).[1] For management the AF guidelines advise to follow the Atrial fibrillation Better Care (ABC) pathway, which represents care to (i) avoid stroke, (ii) better symptom control, and (iii) take care of co-morbidities and cardiovascular risk factors. Despite the lack of data to show clinical effectiveness, AF screening is advocated saying that once AF is detected outcome worsens. It is also recommended to measure the quality of care over time and when needed improve care in an iterating cycle of improvement. The guidelines also highlight the importance of longitudinal rather than one-time cross-sectional assessment of stroke and bleeding risks since patients may outgrow their low risk status quite rapidly over time. Catheter ablation is advocated to ameliorate AF symptoms and to manage AF-associated heart failure and may be applied after one antiarrhythmic drug failure including failure on beta-blockade.

Figure 1.

The CC to Atrial fibrillation Better Care paradigm in the latest European Society of Cardiology (ESC) guidelines provides a comprehensive and holistic approach towards diagnosis and management of atrial fibrillation. CC stands for Confirmation (first C) and Characterisation (second C) of atrial fibrillation according to the structured 4S-AF scheme including assessment of stroke risk, symptom severity, severity of atrial fibrillation burden, and substrate severity. Reproduced with permission from Ref.1