3
6. Catheter ablation of AF receives a Class 1 indication as first-line
therapy in selected patients: Recent randomized studies have
demonstrated the superiority of catheter ablation over drug therapy
for rhythm control in appropriately selected patients. In view of the
most recent evidence, we upgraded the Class of Recommendation.
7. Catheter ablation of AF in appropriate patients with heart failure
(HF) with reduced ejection fraction (EF) receives a Class 1
indication: Recent randomized studies have demonstrated the
superiority of catheter ablation over drug therapy for rhythm control
in patients with heart failure and reduced ejection failure. In view
of the data, we upgraded the Class of Recommendation for this
population of patients.
8. Recommendations have been updated for device-detected AF: In
view of recent studies, more prescriptive recommendations are
provided for patients with device-detected AF that consider the
interaction between episode duration and the patient's underlying
risk for thromboembolism. This includes considerations for patients
with AF detected via implantable devices and wearables.
9. Left atrial appendage occlusion (LAAO) devices receive higher level
Class of Recommendation: In view of additional data on safety and
efficacy of left atrial appendage occlusion devices, the Class of
Recommendation has been upgraded to 2a compared to the 2019 AF
Focused Update for use of these devices in patients with long-term
contraindications to anticoagulation.
10. Recommendations are made for patients with AF identified during
medical illness or surgery (precipitants): Emphasis is made on the risk
of recurrent AF after AF is discovered during noncardiac illness or other
precipitants, such as surgery.
2. Background and Pathophysiology
2.1. Epidemiology
➤ Atrial fibrillation is the most sustained common arrhythmia, and its
incidence and prevalence are increasing in the United States and
globally (Figure 1; Figure 2; Figure 3).
➤ AF is associated with a 1.5- to 2-fold increased risk of death.
