Atrial Fibrillation Chronic: Identifying Hazards, Solutions, and Prognosis
Recent updates in the diagnosis, treatment, and prevention of persistent atrial fibrillation (AF) have been primarily influenced by the 2024 European Society of Cardiology (ESC) guidelines and recent clinical trials.
**Diagnosis and Risk Stratification:**
The updated risk stratification for thromboembolism in AF patients is now guided by the CHA₂DS₂-VA score, helping doctors make informed decisions about anticoagulation to prevent strokes. Bleeding risk assessment tools have also been refined to better balance stroke prevention with hemorrhagic risk in anticoagulated patients.
**Treatment:**
1. **Catheter Ablation (CA):**
The expanded indication for catheter ablation now includes persistent and long-standing persistent AF, supporting its role beyond paroxysmal AF. The PRAGUE-25 trial has demonstrated that in patients with persistent or long-standing persistent AF and obesity, CA was superior to combined lifestyle modification and antiarrhythmic drugs in achieving freedom from AF at one year. Novel ablation technologies like pulsed field ablation (PFA) are emerging as disruptive advancements, showing promise in efficacy and safety for treating AF, including non-pulmonary vein substrates.
2. **Lifestyle Modification and Antiarrhythmic Drugs:**
Lifestyle interventions, such as weight management, alcohol moderation, and exercise, remain supportive but may be less effective alone compared to ablation in certain populations. Antiarrhythmic drug therapy is still used but with increasing consideration of ablation as a first-line or early strategy, especially in persistent AF.
3. **Multidisciplinary Management:**
The ESC 2024 guidelines promote the AF-CARE pathway, encouraging multidisciplinary, integrated care approaches to optimise outcomes. Targeted online education for healthcare professionals improves adherence to guideline-recommended rhythm control strategies by over 50%, enhancing patient care quality.
4. **Left Atrial Appendage Closure (LAAC):**
New recommendations for LAAC in selected patients unsuitable for long-term anticoagulation are included to prevent stroke.
**Prevention:**
Anticoagulation guided by updated risk scores remains central to preventing AF-related stroke. Increasing emphasis on comprehensive care, including risk factor management (hypertension, diabetes, obesity) and rhythm control tailored to patient characteristics, is emphasised to prevent progression and complications.
In summary, the latest updates reflect a trend towards early and expanded use of catheter ablation, integration of advanced technologies, a strong multidisciplinary management approach, and continuous education to improve adherence to best practices—all aimed at improving outcomes for patients with persistent or long-standing atrial fibrillation.
Treatment for chronic atrial fibrillation aims to minimise the risk of blood clots and return the heart to a normal rhythm, and may include lifestyle changes, medications, pacemakers or similar electronics, procedures to reset the heart's rhythms, surgery, and ablation. Symptoms of chronic atrial fibrillation include fatigue, fluttering feeling in the chest, sweating, dizziness, palpitations, chest pain, anxiety, shortness of breath, general weakness, fainting, and any new onset of these symptoms should seek immediate medical attention.
A-Fib can be difficult to diagnose as many people do not experience symptoms, but a doctor may order an electrocardiogram (ECG), Holter monitor, mobile cardiac monitoring, event monitor, echocardiogram, computed tomography (CT) scan, magnetic resonance imaging (MRI) for diagnosis. Anyone can develop chronic atrial fibrillation, but certain risk factors may increase the likelihood, such as being over age 60, having high blood pressure, diabetes, a history of heart attack, lung disease, thyroid problems, previous open heart surgery, untreated atrial flutter, problems with the structure of the heart, excess alcohol consumption, coronary artery disease, inflammation around the heart, cardiomyopathy, sick sinus syndrome, a family history of atrial fibrillation, other serious illnesses or infections.
Antiarrhythmics can have serious side effects and should only be taken under close supervision in a hospital. Chronic atrial fibrillation is diagnosed when symptoms last for longer than 12 months. Preventing A-fib involves exercising regularly, controlling blood sugar levels, eating a diet rich in omega 3s, fruits, whole grains, and vegetables, avoiding trans and saturated fats, quitting smoking, maintaining a healthy weight, limiting alcohol consumption, managing stress and anxiety, controlling blood pressure, avoiding excess caffeine, and considering talking to a doctor or dietitian for help in making lifestyle changes.
- The expanded indication for catheter ablation now includes chronic diseases such as persistent and long-standing atrial fibrillation (AF), highlighting its role not only in paroxysmal AF but also in managing chronic-diseases like AF.
- Significant advancements in medical-conditions like AF include the use of novel ablation technologies like pulsed field ablation (PFA), which show promise in efficacy and safety for treating AF, including non-pulmonary vein substrates.
- risk factor management plays a crucial role in preventing progression and complications of chronic-diseases like AF, and this includes managing blood pressure, diabetes, and obesity as well as lifestyle interventions such as regular exercise, alcohol moderation, and weight management.
- The science of cardiovascular health continuously evolves, with recent updates promoting the early and expanded use of catheter ablation, integration of advanced technologies, a strong multidisciplinary management approach, and continuous education to improve adherence to best practices—all aimed at improving heart health and reducing the risk associated with chronic-diseases like AF.
- Prevention of disease-related complications and strokes, such as those associated with AF, is primarily focused on anticoagulation guided by updated risk scores and comprehensive care that includes managing risk factors and utilizing rhythm control strategies tailored to patient characteristics.
