Atrial Fibrillation Occurring During Acute Hospitalization: A Scientific Statement From the American Heart...

Area of Science:

• Cardiology
• Internal Medicine
• Clinical Management

Background:

• Acute atrial fibrillation is detected during acute illness or care, often during hospitalization for other conditions.
• Atrial fibrillation post-cardiothoracic surgery is a specific subtype requiring distinct consideration.
• This condition carries a high risk of long-term recurrence, necessitating clinical vigilance.

Purpose of the Study:

• To outline a framework for evaluating and managing acute atrial fibrillation.
• To emphasize the importance of interdisciplinary collaboration in acute care.
• To detail strategies for both acute and long-term patient management.

Main Methods:

• Utilizing a substrate and trigger framework for evaluation.
• Implementing a multipronged acute management approach.
• Individualizing rate/rhythm control and anticoagulation strategies based on patient factors.

Main Results:

• Acute management focuses on trigger identification/treatment, rate/rhythm control, and anticoagulation.
• Long-term management involves heart rhythm monitoring, lifestyle modification, and risk factor management.
• Individualized treatment plans are crucial for both acute and long-term care.

Conclusions:

• Acute atrial fibrillation management requires a comprehensive approach addressing underlying substrates and triggers.
• The "3 As" (acute triggers, atrial fibrillation rate/rhythm, anticoagulation) guide acute care.
• The "2 As and 2 Ms" (atrial fibrillation rate/rhythm, anticoagulation, monitoring, modification) guide long-term care, with research gaps identified.