Recorded live on January 25th, 2024.

In this recorded Cardiology Grand Rounds presentation, Dr.s Marco Perez and Mark Hlatky discuss the latest ACC/AHA atrial fibrillation guidelines (AF) released in November 2023. They provide key updates, including introducing the concept of AF stages, revising the definition of AF, and providing guidance on screening for AF, stroke prevention strategies, rhythm control approaches, and management of early-onset AF. For stroke prevention, the guidelines recommend using risk stratification tools like CHADS-VASC, preferring DOACs over warfarin, and considering left atrial appendage occlusion devices in specific cases. In addition, regarding rhythm control, the guidelines support early rhythm control, with ablation as a first-line option in certain patient populations, including those with heart failure. The presentation concludes with ongoing research areas, including the REACT AF trial, factor XI inhibitors, and pulsed-field ablation.

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Learning Objectives:
1. Refer patients with early-onset atrial fibrillation (age less than 45 years) for genetic testing and counseling, and those younger than 30 years for electrophysiological (EP) studies.
2. Consider referring low-burden atrial fibrillation patients (CHADS-VASC score 1-4) to the REACT atrial fibrillation trial for evaluation of a pill-in-pocket anticoagulation strategy.
3. Implement strategies to optimize modifiable risk factors in AF patients, such as weight loss, exercise, smoking cessation, and alcohol abstinence.
4. Evaluate the use of left atrial appendage occlusion devices in patients with contraindications to anticoagulation or as an alternative to anticoagulation in selected cases.
5. Consider early rhythm control, potentially with ablation as a first-line option, in appropriate patient populations, including those with heart failure.
6. Utilize risk stratification tools like CHADS-VASC or others for stroke prevention and prefer DOACs over warfarin in most cases.
7. Screen patients who have had a stroke or systemic embolus using implantable loop recorders to detect subclinical atrial fibrillation.


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