An EXCITING NEW guideline from @escardio at #ESCCongress on Atrial Fibrillation. It’s a long read of 126 but enjoyable! Here are my top tips from this guideline… #epeeps Link: https://bit.ly/2YRdX8S  @mmamas1973 @pash22 @Hragy @DrMarthaGulati @ErinMichos @AnastasiaSMihai /THEAD

FOCUS is on CONFIRMING AF (12 lead >30s) and CHARACTERISING it…
The 4S….

Stroke Risk…
Symptom Severity…
Severity Burden of AF
Substrate of AF

@KTamirisaMD @StavrosStavrak1 @StavrosDrakos @JonathanBehar @bogdienache @mencardio
#ESCCongress /3

AF ESC GUIDELINE Tweetorial

Stroke Risk – Simple – CHA2DS2-VASc Score
& HAS-BLED, to stratify bleeding
Symptom severity- Use the EHRA symptom scale
Burden- paroxysmal, persistent, permanent and if paroxysmal how frequently
Substrate of AF- comorbidities #ESCCongress /4

AF ESC GUIDELINE Tweetorial #ESCCongress /5

Clear message about identification of AF on Atrial High Rate episodes on devices (pacemakers, implantable loop recorders) … Need to see an one lead ECG & there too need >30s. If not able to get this then close monitoring @ecgrhythms

AF ESC GUIDELINE Tweetorial #ESCCongress /6

AF is common… More prevalent in Elderly, Men, Caucasian, lower socioeconomic calss, those with increased cardiometabolic risks and portends an adverse prognosis
@HeartOTXHeartMD @DrToniyaSingh @rahatheart1 @CardioIAN @RafKotronias

AF ESC GUIDELINE Tweetorial #ESCCongress /6
AF is only part of the spectrum of disease for that individual…Everything else needs to be managed too…
Coronary disease
Hypertension
Obesity
Lack of exercise
Diabetes
Kidney failure
at least 6 & 12 month review initially @duanepinto

AF ESC GUIDELINE Tweetorial #ESCCongress /7
New start like the ABC!
A-Anticoagulation – Easy CHA2DS2-VASc score – anticoagulate any man≥1 £ woman≥2 (remember sex is risk modifier not a risk predictor, so I cannot see how women can have score=1 (quoted in the algorithm below)

AF ESC GUIDELINE Tweetorial #ESCCongress /8

Still on A... Check Bleeding risk – HAS-BLED if >3 aim to optimise any reversible conditions… do NOT withhold anticoagulation even if HAS-BLED is high.
@wordfinga @mancunianmedic @duanepinto @SaludHEALTHinfo @pabeda1 @VietHeartPA

AF ESC GUIDELINE Tweetorial #ESCCongress /8

B – Better symptom control – rate controlled preferred! Rhythm controlled also suggested… and EMPHASIS on decision being PATIENT centred

C – cardiovascular risk management – put simple… manage all other cardiac conditions and risk

AF ESC GUIDELINE Tweetorial #ESCCongress /9

Never forget Adherence… it is crucial!

@DrRajivsankar @corinne8154 @novitskiynic @MichaelPapadak2 @DrMichail @psmedic @drahmadzubair @AnkurGuptaMD @timir_paul @hannahcvimaging @hannahzr @SSharmacardio @ShraboniGhosal @docjohnnyg

AF ESC GUIDELINE Tweetorial #ESCCongress /10

Can we predict the future of AF? We know that short episodes become longer and then paroxysmal AF becomes permanent… but here… #whycmr gets a central SPOT! Even as a CMR enthusiast I don't think many centres can identify LA fibrosis

AF ESC GUIDELINE Tweetorial #ESCCongress /11
And on Atrial High Rate Episodes… we will be seeing a lot more of this… but is a 31s AF so different to 28s? We know AF is progressive so I believe more emphasis should be put on the CHA2DS2-VASc score than duration @DrPascalMeier

AF ESC GUIDELINE Tweetorial #ESCCongress /12
And I think I missed some key messages in the flow of the tweetorial!

Heart rate - don't go too low... <110 bpm seems ok

@HolgerNef @PaulDendale @ProfessorHalle @PMarquesVidal @majalisalochen1 @DrTiberi @TharushaGunawa4 @justvick

AF ESC GUIDELINE Tweetorial #ESCCongress /END -1

Rhythm control or Cardioversion? Putting the patient in control... unless rhythm strategy really fails...

@HEARTinMagnet @hvanspall @heartdoc45 @HanCardiomd @Izanagi_no_mi_ @CJohnston1903 @LopezOpitz @Vilavaite @Kfarooqi

AF ESC GUIDELINE Tweetorial #ESCCongress / THE END

In short...get the right diagnosis, put the patients on the right management for AF and other conditions (including lifestyle, exercise, nutrition) then rate control-->rhythm control & work as a partnership @exerciseworks