The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation.A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate.Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed. 

2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.

2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)

The “2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Patients With Atrial Fibrillation” provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the “2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation” and the “2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation” have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed. 

2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.

Purpose: Improving cardiorespiratory fitness (CRF) through exercise training is associated with lower morbidity and mortality in patients with atrial fibrillation (AF). Smaller CRF improvements have been suggested in females than males with cardiovascular disease following exercise training. This systematic review compared changes in CRF (primary) and additional physical and mental health outcomes following exercise training between females and males with AF. Review Methods: Five bibliographic databases were searched to identify prospective studies implementing exercise training in patients with AF. The mean difference (MD) in the change following exercise training was compared between sexes using random-effects meta-analyses. Summary: Sex-specific data were obtained from 19 of 63 eligible studies, with 886 participants enrolled in exercise training (n = 259 [29%] females; female: 68 ± 7 years, male: 66 ± 8 years). Exercise training was 6 weeks to 1 year in duration and mostly combined moderate- to vigorous-intensity aerobic and resistance training, 2 to 6 d/wk. Changes in CRF did not differ between sexes (MD = 0.15: 95% CI, −1.08 to 1.38 mL O 2 /kg/min; P = .81; I 2 = 27%). Severity of AF (MD = 1.00: 95% CI, 0.13-1.87 points; I 2 = 0%), general health perceptions (MD = −3.71: 95% CI, −6.88 to −0.55 points; I 2 = 22%), and systolic blood pressure (MD = 3.11: 95% CI, 0.14-6.09 mmHg; I 2 = 42%) improved less in females than in males. Females may benefit from more targeted exercise training programs given their smaller improvement in several health outcomes than males. However, our findings are largely hypothesis-generating, considering the limited sample size and underrepresentation of females (29% females in our review vs 47% females with AF globally). 

Sex Differences in Changes in Cardiorespiratory Fitness and Additional Health Outcomes Following Exercise Training in Adults With Atrial Fibrillation

Zusammenfassung Vorhofflimmern, die häufigste anhaltende Herzrhythmusstörung, ist mit einer erheblichen Morbidität, Mortalität und Inanspruchnahme von Gesundheitsleistungen verbunden. Vor dem Hintergrund, dass die zur Rhythmuskontrolle bei Vorhofflimmern eingesetzten Verfahren (Katheterablation, Antiarrhythmika) mit einer Reihe von Einschränkungen und Risiken behaftet sind, besteht ein wachsendes Interesse an erweiterten Behandlungsstrategien. Hierzu gehören eine Optimierung des Lebensstils, die Einstellung von Risikofaktoren für Vorhofflimmern und alternative Behandlungsverfahren, wie z. B. Yoga. Zu dessen Wirkung bei Vorhofflimmern liegen bislang nur wenige Studien vor. Diese sprechen aber dafür, das Yoga tatsächlich in der Lage sein dürfte, die Häufigkeit der Rhythmusstörung und ihre Progression zu vermindern. Auch die Risikofaktoren für Vorhofflimmern und die Lebensqualität werden positiv beeinflusst. Da unerwünschte Effekte und Komplikationen bei kompetenter Anleitung selten sind, kann regelmäßiges Yoga jetzt schon empfohlen werden. Um eindeutige, evidenzbasierte, praktische Empfehlungen geben zu können, sind aber weitere klinische Studien notwendig. 

/pdf/alternative-behandlungsverfahren-bei-vorhofflimmern-1v97ed3h.pdf

Alternative Behandlungsverfahren bei Vorhofflimmern

In Brief Purpose: Atrial fibrillation (AF) is associated with the comorbidities of a sedentary lifestyle. Endurance athletes also show an increased incidence of AF. The role of exercise in the treatment of AF is unknown so this study aimed to examine the effects of supervised exercise on AF. Methods: A meta-analysis of randomized controlled trials (RCTs) examining supervised exercise training in participants with AF was performed. The primary outcome was AF recurrence and burden. Secondary outcomes included AF symptoms, quality of life, and cardiorespiratory fitness (CRF). Results: Thirteen RCTs, involving 1155 participants, were included. Paroxysmal AF was present in 34% and persistent AF in 64%. The types of exercise were diverse and included cardiac rehabilitation (64%), aerobic training (7%), Qi Gong (4%), interval training (11%), and yoga (15%). Exercise training reduced AF recurrence (relative risk = 0.77: 95% CI, 0.60–0.99), improved quality of life in 5 of the 10 components of the Short Form 36 survey, and improved CRF (standardized mean difference [SMD] = 0.56: 95% CI, 0.27–0.85). The AF burden was reduced only in studies that included continuous ambulatory monitoring (SMD =−0.49: 95% CI, −0.96 to −0.01) but not when all studies were included (SMD =−0.12: 95% CI, −0.61 to 0.38). There was no difference in adverse events between exercise and control. Conclusions: Supervised exercise training is safe, reduces AF recurrence, and improves quality of life and CRF in participants with AF. Further large RCTs with ambulatory monitoring and robust exercise regimens are needed to assess the effects of exercise training on AF burden and AF symptoms. The role of exercise for treatment of atrial fibrillation (AF) is unknown. A meta-analysis of randomized controlled trials examining exercise training in participants with AF was performed. Exercise training reduced AF recurrence, improved quality of life, and improved cardiorespiratory fitness. AF burden was reduced in studies that included continuous monitoring. 

Effects of Supervised Exercise Training on Atrial Fibrillation

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Effects of Supervised Exercise Training on Atrial Fibrillation