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

The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of nonvitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to Received for publication August 9, 2018. Accepted August 15, 2018. *For a full listing of primary and secondary panel members, see the Supplementary Material. Corresponding author: Dr Laurent Macle, Electrophysiology service, Montreal Heart Institute, Universit e de Montr eal, 5000 est, rue B elanger, Montr eal, Qu ebec H1T 1C8, Canada. Tel.: þ1-514-376-3330. E-mail: lmacle@mac.com The disclosure information of the authors and reviewers is available from the CCS on their guidelines library at www.ccs.ca. This statement was developed following a thorough consideration of medical literature and the best available evidence and clinical experience. It represents the consensus of a Canadian panel comprised of multidisciplinary https://doi.org/10.1016/j.cjca.2018.08.026 0828-282X/ 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. A R ESUM E Le comit e des lignes directrices en matière de fibrillation auriculaire de la Soci et e canadienne de cardiologie (SCC) procède à des examens p eriodiques des nouvelles donn ees pour produire des mises à jour th ematiques portant sur des avanc ees cliniquement importantes de la prise en charge de la fibrillation auriculaire (FA). La mise à jour cibl ee 2018 porte sur les aspects suivants : 1) l’anticoagulation dans le contexte de la cardioversion de la FA; 2) la prise en charge du traitement antithrombotique des patients atteints de FA dans le contexte d’une coronaropathie; 3) la recherche et la prise en charge de la FA sub-clinique; 4) les antidotes aux anticoagulants oraux non-vitamine K; 5) cardioversion pharmacologique aiguë de la FA; 6) l’ablation par experts on this topic with a mandate to formulate disease-specific recommendations. These recommendations are aimed to provide a reasonable and practical approach to care for specialists and allied health professionals obliged with the duty of bestowing optimal care to patients and families, and can be subject to change as scientific knowledge and technology advance and as practice patterns evolve. The statement is not intended to be a substitute for physicians using their individual judgement in managing clinical care in consultation with the patient, with appropriate regard to all the individual circumstances of the patient, diagnostic and treatment options available and available resources. Adherence to these recommendations will not necessarily produce successful outcomes in every case.