The ESC 2020 guidelines on the management of patients with atrial fibrillation (AF) – Diagnostics

During ESC eCongress 2020 the new guidelines on the management of patients with atrial fibrillation were presented. It was assessed that lifetime risk for AF for individuals of 55 year of age is around one third. The purpose of current guideline is to facilitate uniform structured approach to AF care on each level of care. Management approach was summarized in five domains: CC -> ABC. In terms of diagnostics – CC: Confirm AF; Characterise Clinically. Authors introduced two categories of AF: clinical AF (episodes duration of > 30 s in single channel ecg or AF detected in 12-lead ecg) and subclinical AF (based on the evaluation of AHRE episodes stored in cardiac implantable electronic devices memory diagnosed with implantable loop recorders). Sensitivity of commonly available ambulatory screening tests to suspect AF (pulse taking, automated BP monitors, single lead ecg, smartphone apps, watches) range from 87 to 100% and specificity from 70 to 100%. Risk of stroke increases in patients with AHRE with higher daily burden and higher thromboembolic risk. Management of patients with AF is based on the ABC scheme: Anticoagulation / avoid stroke, Better symptom control, Comorbidities / Cardiovascular risk factor management.