Guideline of atrial fibrillation management

Article information

J Korean Med Assoc. 2019;62(5):265-274

Publication date (electronic) : 2019 May 16

doi : https://doi.org/10.5124/jkma.2019.62.5.265

Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Corresponding author: Boyoung Joung. cby6908@yuhs.ac

Received 2019 February 02; Accepted 2019 April 09.

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.

Keywords: Atrial fibrillation; Guideline; Anticoagulants; Therapy

References

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Korean Medical Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

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.

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].

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].

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].

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].

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].

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].

Table 1

CHA₂DS₂-VASc scoring system

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

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

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).