Canadian Journal of Cardiology

2014 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation

Published:August 13, 2014DOI:https://doi.org/10.1016/j.cjca.2014.08.001

      Abstract

      Atrial fibrillation (AF) is an extremely common clinical problem with an important population morbidity and mortality burden. The management of AF is complex and fraught with many uncertain and contentious issues, which are being addressed by extensive ongoing basic and clinical research. The Canadian Cardiovascular Society AF Guidelines Committee produced an extensive set of evidence-based AF management guidelines in 2010 and updated them in the areas of anticoagulation and rate/rhythm control in 2012. In late 2013, the committee judged that sufficient new information regarding AF management had become available since 2012 to warrant an update to the Canadian Cardiovascular Society AF Guidelines. After extensive evaluation of the new evidence, the committee has updated the guidelines for: (1) stroke prevention principles; (2) anticoagulation of AF patients with chronic kidney disease; (3) detection of AF in patients with stroke; (4) investigation and management of subclinical AF; (5) left atrial appendage closure in stroke prevention; (6) emergency department management of AF; (7) periprocedural anticoagulation management; and (8) rate and rhythm control including catheter ablation. This report presents the details of the updated recommendations, along with their background and rationale. In addition, a complete set of presently applicable recommendations, those that have been updated and those that remain in force from previous guideline versions, is provided in the Supplementary Material.

      Résumé

      La fibrillation auriculaire (FA) est un problème clinique très fréquent représentant un fardeau important de la morbidité et de la mortalité de la population. La prise en charge de la FA est complexe et comporte plusieurs questions incertaines et controversées, qui sont actuellement abordées par la recherche fondamentale et clinique approfondie. En 2010, le comité des lignes directrices sur la FA de la Société canadienne de cardiologie a produit un vaste ensemble de lignes directrices sur la prise en charge de la FA fondées sur des données probantes et les a mises à jour en 2012 dans les domaines de l’anticoagulation du contrôle de la fréquence et du rythme. À la fin de 2013, le comité a estimé que les nouvelles informations sur la prise en charge de la FA qui sont disponibles depuis 2012 étaient suffisantes pour justifier une mise à jour des lignes directrices sur la FA de la Société canadienne de cardiologie. Après l’évaluation approfondie des nouvelles données probantes, le comité a mis à jour les lignes directrices sur : 1) les principes de prévention de l’accident vasculaire cérébral; 2) l’anticoagulation des patients atteints d’une maladie rénale chronique qui ont une FA; 3) la détection de la FA chez les patients qui subissent un accident vasculaire cérébral; 4) l’évaluation et la prise en charge de la FA subclinique; 5) la fermeture de l’appendice auriculaire gauche dans la prévention de l’accident vasculaire cérébral; 6) la prise en charge de la FA par le service des urgences; 7) la prise en charge péri-interventionnelle de l’anticoagulation; 8) le contrôle de la fréquence et du rythme, y compris l’ablation par cathéter. Ce rapport présente de manière détaillée les recommandations mises à jour, ainsi que leur fondement et leurs justifications. De plus, l’ensemble des recommandations actuellement applicables, celles qui ont été mises à jour et celles des versions précédentes des lignes directrices qui demeurent en vigueur, est fourni dans une Liste complète des lignes directrices comme documentation complémentaire.

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      Linked Article

      • Erratum
        Canadian Journal of CardiologyVol. 30Issue 12
        • In Brief
          In the article, “2014 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation” by Verma et al, published in the October issue (Can J Cardiol 2014;30:1114-30), there is an error in the affiliations. The affiliation for Ian G. Stiell, MD, should be listed as Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
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      • Erratum
        Canadian Journal of CardiologyVol. 31Issue 10
        • In Brief
          In the article “2014 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation” by Verma et al., published in the October 2014 issue of the Canadian Journal of Cardiology (Can J Cardiol 2014;30:1114-30), the authors wish to correct unfortunate errors that crept into the text:
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