ACC/AHA Issue Updated Atrial Fibrillation Guideline

The 2023 ACC/AHA/ACCP/HRS Guideline for Diagnosis and Management of Atrial Fibrillation was published online today in the Journal of the American College of Cardiology and Circulation.

The previous classification was largely based only on arrhythmia duration and tended to emphasize specific therapeutic interventions rather than a more holistic and multidisciplinary management approach.

The new proposed classification, using four stages, recognizes AF as a disease continuum that requires a variety of strategies at different stages, from prevention, lifestyle and risk factor modification, screening, and therapy.

  • Stage 1: At risk for AF due to the presence of risk factors

  • Stage 2: Pre-AF, with evidence of structural or electrical findings predisposing to AF

  • Stage 3: AF, including paroxysmal (3A), persistent (3B), long-standing persistent (3C), successful AF ablation (3D)

  • Stage 4: Permanent AF

The updated guideline recognizes lifestyle and risk factor modification as a "pillar" of AF management and offers "more prescriptive" recommendations, including management of obesity, weight loss, physical activity, smoking cessation, alcohol moderation, hypertension, and other comorbidities.