Practical Comprehensive Approach to Current Atrial Fibrillation Challenges: Insights from an Expert Panel.

Area of Science:

• Cardiology
• Electrophysiology
• Internal Medicine

Background:

• Atrial fibrillation (AF) is a prevalent arrhythmia and a leading cause of embolic events.
• Timely diagnosis and treatment of AF are essential for preventing thromboembolic complications.
• Direct Oral Anticoagulants (DOACs) represent an advancement, yet their optimal use in AF management requires further refinement.

Purpose of the Study:

• To evaluate current evidence and expert consensus on the clinical management of atrial fibrillation.
• To develop practical recommendations for improving patient care in AF.

Main Methods:

• A questionnaire was developed by a scientific committee, incorporating a literature review on AF diagnosis, stroke prevention, rate/rhythm control, and comorbidity management.
• Expert panelists rated statements using a 5-point Likert scale to assess agreement.
• Results were discussed in a final meeting to formulate practical recommendations.

Main Results:

• Thirty-five Spanish AF management experts participated.
• High agreement (78%) was achieved on most statements, with some discrepancies (9%) and rejections (13%).

Conclusions:

• A 12-lead electrocardiogram is vital for AF diagnosis, complemented by wearable devices.
• Catheter ablation is favored over pharmacotherapy for rhythm control.
• Managing comorbidities is key to reducing AF incidence and recurrence.
• Patient adherence and persistence are critical for anticoagulation efficacy and safety.
• DOACs, specifically apixaban and edoxaban, are preferred for stroke prevention in elderly patients (≥75 years) or those with chronic kidney disease.