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J Korean Med Assoc > Volume 62(5); 2019 > Article
Joung: Guideline of atrial fibrillation management

Abstract

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the general population. The Korean Heart Rhythm Society organized a Korean Atrial Fibrillation Management Guideline Committee and analyzed all available studies regarding the management of AF, including studies on Korean patients. This guideline is based on recent data of the Korean population and the recent guidelines of the European Society of Cardiology, European Association for Cardio-Thoracic Surgery, American Heart Association, and Asia Pacific Heart Rhythm Society. Expert consensus or guidelines for the optimal management of Korean patients with AF were achieved after a systematic review with intensive discussion. This article provides general principles for appropriate risk stratification and selection of anticoagulation therapy in Korean patients with AF. This guideline deals with optimal stroke prevention, screening, rate and rhythm control, risk factor management, and integrated management of AF.

References

1. Joung B, Lee JM, Lee KH, Kim TH, Choi EK, Lim WH, Kang KW, Shim J, Lim HE, Park J, Lee SR, Lee YS, Kim JB. KHRS Atrial Fibrillation Guideline Working Group. 2018 Korean guideline of atrial fibrillation management. Korean Circ J 2018;48:1033-1080.
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2. Kim D, Yang PS, Jang E, Yu HT, Kim TH, Uhm JS, Kim JY, Pak HN, Lee MH, Joung B, Lip GY. 10-Year nationwide trends of the incidence, prevalence, and adverse outcomes of non-valvular atrial fibrillation nationwide health insurance data covering the entire Korean population. Am Heart J 2018;202:20-26.
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3. Kim D, Yang PS, Jang E, Yu HT, Kim TH, Uhm JS, Kim JY, Pak HN, Lee MH, Joung B, Lip GYH. Increasing trends in hospital care burden of atrial fibrillation in Korea, 2006 through 2015. Heart 2018;104:2010-2017.
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4. Yang PS, Ryu S, Kim D, Jang E, Yu HT, Kim TH, Hwang J, Joung B, Lip GY. Variations of prevalence and incidence of atrial fibrillation and oral anticoagulation rate according to different analysis approaches. Sci Rep 2018;8:6856.
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5. Lee H, Kim TH, Baek YS, Uhm JS, Pak HN, Lee MH, Joung B. The trends of atrial fibrillation-related hospital visit and cost, treatment pattern and mortality in Korea: 10-year nationwide sample cohort data. Korean Circ J 2017;47:56-64.
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6. Lee SR, Lee YS, Lim WH, Kim TH, Cha MJ, Lee JH, Baek YS, Lim HE, Joung B, Kim JS, Lee MY. 2018 Korean Heart Rhythm Society guidelines for detection and management of risk factors and concomitant cardiovascular diseases in Korean patients with atrial fibrillation. Korean J Med 2018;93:324-335.
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7. Kim D, Yang PS, Kim TH, Jang E, Shin H, Kim HY, Yu HT, Uhm JS, Kim JY, Pak HN, Lee MH, Joung B, Lip GY. Ideal blood pressure in patients with atrial fibrillation. J Am Coll Cardiol 2018;72:1233-1245.
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Figure 1

Annual prevalence (A) and incidence (B) of atrial fibrillation (AF), 2006-2015, stratified by sex. Reproduced from Joung B et al. Korean Cir J 2018;48:1033-1080, according to the Creative Commons license [1]. a)P<0.05. b)P<0.001.

jkma-62-265-g001-l.jpg
Figure 2

Annual incidence (A) and prevalence (B) of atrial fibrillation (AF), 2006-2015, stratified by age. Reproduced from Joung B et al. Korean Cir J 2018;48:1033-1080, according to the Creative Commons license [1]. a)P<0.05. b)P<0.001.

jkma-62-265-g002-l.jpg
Figure 3

The projected prevalence of atrial fibrillation. Reproduced from Joung B et al. Korean Cir J 2018;48:1033-1080, according to the Creative Commons license [1].

jkma-62-265-g003-l.jpg
Figure 4

Temporal trends of newly diagnosed atrial fibrillation patient by CHA2DS2-VASc (A) and HAS-BLED scores (B), 2006-2015. Reproduced from Joung B et al. Korean Cir J 2018;48:1033-1080, according to the Creative Commons license [1].

jkma-62-265-g004-l.jpg
Figure 5

Temporal trends in 1-year adverse event rates of prevalent atrial fibrillation Korean population each year. HF, heart failure. a)P-value for trends <0.001. Reproduced from Joung B et al. Korean Cir J 2018;48:1033-1080, according to the Creative Commons license [1].

jkma-62-265-g005-l.jpg
Figure 6

The basic concept of acute and chronic management of atrial fibrillation. OAC, oral anticoagulation therapy; VKA, vitamin K antagonist; TTR, time in therapeutic range; NOAC, non-vitamin K antagonist oral anticoagulant. Reproduced from Joung B et al. Korean Cir J 2018;48:1033-1080, according to the Creative Commons license [1].

jkma-62-265-g006-l.jpg
Figure 7

Stroke prevention strategy in patients with atrial fibrillation. NOAC, non-vitamin K oral anticoagulant; OAC, oral anticoagulation. a)A congestive heart failure, hypertension, age ≥75 (doubled), diabetes mellitus, prior stroke or transient ischemic attack (doubled), vascular disease, age 65-74, female. Reproduced from Joung B et al. Korean Cir J 2018;48:1033-1080, according to the Creative Commons license [1].

jkma-62-265-g007-l.jpg
Figure 8

Management of bleeding in patients taking oral anticoagulants. INR, international normalized ratio; IV, intravenous; NOAC, non-vitamin K oral anticoagulant. Adapted from Joung B et al. Korean Cir J 2018;48:1033-1080 [1].

jkma-62-265-g008-l.jpg
Table 1

CHA2DS2-VASc scoring system

jkma-62-265-i001-l.jpg

Adapted from Kirchhof P et al. Eur Heart J 2016;37:2893-2962 [11].

a)≥4 mm or ulcerative or mobile plaque.

Table 2

Indication and contraindication for NOAC in patient with atrial fibrillation

jkma-62-265-i002-l.jpg

NOAC, non-vitamin K antagonist oral anticoagulant; PTAV, percutaneous transluminal aortic valvuloplasty; TAVI, transcatheter aortic valve implantation.

Adapted from Steffel J et al. Eur Heart J 2018;39:1330-1393 [13].

Table 3

Dose reduction of non-vitamin K antagonist oral anticoagulants

jkma-62-265-i003-l.jpg

Reproduced from Joung B et al. Korean Cir J 2018;48:1033-1080, according to the Creative Commons license [1]. bid, bis in die (twice a day); qd, quaque die (once a day).

a)Amiodarone, verapamil, dronedarone, etc. b)Coagulopathy, thrombocytopenia, platelet dysfunction, recent major trauma or biopsy, infective endocarditis. c)Should be used with caution in patients with significant renal impairment (creatinine clearance 15-29 mL/min).



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