This week's podcast discusses the new American AF treatment guidelines
I discuss three big changes in the 156-page document on the This Week in Cardiology podcast
The purpose of this note is twofold. One is to remind everyone that I do a weekly recap of cardiology news on a podcast hosted by Medscape called This Week in Cardiology. It’s intended for medical professionals but it’s not too technical. I include the links at the end of this post.
The second reason to write is to alert you to the new American atrial fibrillation guidelines released on November 30. This massive 156-page document updates the 2019 guidelines. (It’s open access.)
Friday on This Week in Cardiology, I addressed three major changes in the new guidelines.
The biggest change was an upgrade in the recommendation for AF ablation in patients with heart failure. The old 2019 recommendation to do AF ablation in the presence of heart failure was a 2b, which is the lowest level. This year the writers upgraded the recommendation to IA—the highest level. Teaser: there is a nuance in using this new guidance.
Another change in guidance I discussed on the podcast was a new emphasis on early rhythm control. This means that doctors should act early to convert AF to sinus rhythm and then try to maintain sinus rhythm. I am not opposed to this in selected patients. I do oppose the concept that this should be the deferred strategy in most or all patients. One of my favorite sayings about AF treatment in most patients is…give peace a chance.
The third change in guidance included an upgrade in the recommendation to do left atrial appendage closure. This, too, I found problematic. On the podcast, I reiterated that the evidence underpinning this preventive procedure is dubious. And new evidence is hardly reassuring.
This Week in Cardiology Podcast links:
On theheart.org | Medscape Cardiology website (includes a partial transcript)
I am now working on my Top-Ten cardiology stories of 2023. I’ve posted such a recap the last few years on Medscape.
Thanks for reading and welcome to the new subscribers. You can also find my work over at the Sensible Medicine substack where I write a study-of-the-week every Monday.
JMM
156 pages? Cardiologists must be brilliant and have time off to keep up. Amazing.
I live in the Afib ablation Capitol of the world . More afib ablations per capita then anywhere else I would suspect .As my colleague once said there are the smallest "p waves" ever seen with probably minimally functioning atria but sinus it is. In the absence of CHF with the new anticoagulants is asymptomatic rate controlled afib the disease or is the chase for sinus rhythm the disease ? Asking for a friend