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2020 Atrial Fibrillation Guidelines

Presented by
Prof. Gerhard Hindricks, Heart Centre Leipzig, Germany
ESC 2020
The new 2020 atrial fibrillation (AF) guidelines advocate that patients with AF and their medical team should practice shared decision-making regarding treatment choices. The new guidelines were a collaboration between the European Society of Cardiology (ESC) and the European Association of Cardio-Thoracic Surgery (EACTS).

The new 2020 guidelines were presented at the ESC Congress 2020 by Prof. Gerhard Hindricks (Guidelines Task Force Chair; Heart Centre Leipzig, Germany), and published simultaneously online in the European Heart Journal [1,2]. “Patients want to be involved in decisions about their care and their preferences should be respected,” said Prof. Hindricks.

Central to the new guidelines is an individualised approach to the Atrial fibrillation Better Care (ABC) pathway:

    • Anticoagulation/Avoid stroke refers to anticoagulation medication for the prevention of stroke where risk is indicated.
    • Better symptom management strives to manage heart rate and heart rhythm with medications and procedures.
    • Cardiovascular and Comorbidity optimisation covers high blood pressure management and lifestyle changes including smoking cessation, weight management, and exercise.

An individualised care plan should be formulated to address patient preferences and physical characteristics. Prevention of stroke remains an essential component for most patients. This year’s update gave additional consideration to specific patient characteristics. For example, pregnant women with AF taking warfarin should avoid vaginal delivery, and endurance athletes are at higher risk for AF, but those participating in contact sports should avoid oral anticoagulants due to bleeding risk.

Accumulating data concerning population screening to identify people with previously undiagnosed AF suggests pre-symptomatic intervention to prevent stroke in these individuals is effective. Wearable devices (e.g. smart wrist bands coupled with smartphone apps) are a remarkable breakthrough, but the guidelines caution that many are not clinically validated for AF detection. A summary of changes in the guidelines from 2016 to 2020 are summarised in the Table.


Table: Summary of AF Guideline changes from 2016 to 2020 [2]

Reprinted from Hindricks G, et al. Eur Heart J. 2020 [Epub ahead of print]. Copyright 2020, with permission from Oxford University Press.AAD, antiarrhythmic drug; AF, atrial fibrillation; NOAC, non-vitamin K antagonist oral anticoagulant; OAC, oral anticoagulant; OSA, obstructive sleep apnoea; PCI, percutaneous coronary intervention; PRO, patient-reported outcome; VKA, vitamin K antagonist therapy.
aClass of recommendation.


    1. Hindricks G, et al. 2020 ESC Guidelines on Atrial Fibrillation. 2020 New ESC Guidelines, ESC Congress 2020, 29 Aug.
    2. Hindricks G, et al. Eur Heart J. 2020;ehaa612.DOI:10.1093/eurheartj/ehaa612.


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