Executive Summary of the II Brazilian Guidelines for Atrial Fibrillation

Since 2009, when the Brazilian Society of Cardiology released the Brazilian Guidelines for Atrial Fibrillation,1 important studies on the subject have been published, particularly on new oral anticoagulants (NOACs). At least three of these drugs (dabigatran, rivaroxaban and apixaban) are currently approved for clinical use in Brazil. In addition to pharmacological treatment, new data related to non-pharmacological treatment, notably the radiofrequency ablation (RA) procedure, have expanded the indication of this therapeutic approach. For this reason, an update of the guidelines is justified. Epidemiological changes in atrial fibrillation In the last two decades, atrial fibrillation (AF) has become a public health problem, with high consumption of health resources. is the most frequent sustained arrhythmia in the clinical practice, with a prevalence of 0.5% - 1.0% in the general population. According to more recent studies, however, prevalence is almost two times higher than that in the last decade, ranging from 1.9% in Italy to 2.9% in Sweden, possibly associated with age increase.2 However, in addition to ageing, other potential factors may explain the increment in prevalence, including advances in the treatment of chronic heart diseases, leading to greater number of patients susceptible to AF. Furthermore, besides the classical risk factors for - hypertension, diabetes mellitus, heart valve disease, heart infarction and heart failure (HF)3,4 -new potential ones, including obstructive sleep apnea,5 obesity,6 alcohol consumption,7 physical exercise,8 family history and genetic factors,9 contribute to the increase in prevalence. The most used classification in the clinical practice is based on its form of presentation. Paroxysmal AF is defined as an episode of that terminates spontaneously or with medical intervention within seven days of onset. The term permanent AF refers to episodes longer than seven days, and long-term persistent AF is used by some authors to refer to cases longer than one year. Finally, the term permanent AF is used when attempts to convert to sinus rhythm have been abandoned. The prognosis of is related to its close association with increased risk of ischemic and hemorrhagic stroke, and mortality. Other important consequences of include cognitive changes and socioeconomic implications