Interpretation of update key points of 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation
The 2019 guideline update for the Diagnosis and Management of atrial fibrillation was jointly published by the American College of Cardiology(ACC),American Heart Association(AHA),American College of Chest Physicians(ACCP),and Heart Rhythm Society(HRS)on November 30,2023.This article aims to interpret key updates in the new guideline,including recommendations for different stages of atrial fibrillation,modification and prevention of atrial fibrillation risk factors,flexibility in using clinical risk scores beyond CHA2DS2-VASc for predicting stroke and systemic embolism,consideration of stroke risk modifiers,early rhythm control,and the use of catheter ablation as a first-line therapy in selected patients.The guideline also provides recommendations for catheter ablation of atrial fibrillation in patients with heart failure with reduced ejection fraction,updates for device-detected atrial fibrillation,higher level Class of Recommendation for left atrial appendage occlusion devices,and guidance for managing atrial fibrillation in patients identified during medical illness or surgery.