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

## TL;DR

Experts developed practical recommendations for managing atrial fibrillation, emphasizing early diagnosis, optimal anticoagulation, and comorbidity management.

## Contribution

A new set of expert-driven practical recommendations for AF management based on recent evidence and consensus.

## Key findings

- A 12-lead electrocardiogram is preferred for AF diagnosis, with wearable devices as useful tools.
- Catheter ablation is preferred over pharmacotherapy for restoring sinus rhythm.
- DOACs like apixaban and edoxaban are preferred for stroke prevention in elderly or kidney disease patients.

## Abstract

Background/Objectives: Atrial fibrillation (AF) is a very common arrhythmia and the main cause of embolic events. Early diagnosis and treatment are crucial to prevent thromboembolic events. Although DOACs are an important advance in AF management, optimization is required. This study aims to evaluate the newly available evidence and experts’ opinions on the clinical care of AF patients and to develop a set of practical recommendations to improve the management of patients with AF. Methods: A questionnaire was developed on the topics of AF diagnosis, stroke prevention, rate and rhythm control, and management of comorbidities, based on the scientific committee’s judgment and a rapid literature review. The level of agreement of the panelists with each statement was evaluated using the Likert 5-point scale. The results of the questionnaire were discussed in a final meeting and practical recommendations were made. Results: Thirty-five Spanish panelists, all experts in AF management, answered the questionnaire. Most of the statements (78%) reached the levels of agreement or unanimity. Discrepancy (9%) and rejection (13%) were also reported. Conclusions: This study underscores the importance of a 12-lead electrocardiogram to diagnose AF, with wearable devices serving as useful tools; catheter ablation as a superior strategy for restoring and maintaining sinus rhythm compared to pharmacotherapy; the importance of comorbidity management to reduce incidence and recurrence of AF; adherence and persistence as critical factors for the efficacy and safety of anticoagulation; and the preference for DOACs, particularly apixaban and edoxaban, for stroke prevention in patients ≥75 years old or with chronic kidney disease.