Recent Atrial Fibrillation Guidelines - Looking at Both Sides of the Atlantic.

The American College of Cardiology (ACC), the American Heart Association (AHA) and the European Society of Cardiology (ESC) reported joint guidelines on atrial fibrillation (AF) in 2001 and a revised version in 2006. In 2010 new guidelines on AF were published by the ESC, and in 2011 by the American College of Cardiology Foundation (ACCF)/AHA/Heart Rhythm Society (HRS) and by the Canadian Cardiac Society (CCS). Focused updates have also appeared more recently. We reviewed these three sets of AF guidelines and compared their rating systems and their recommendations regarding four major AF management aspects (i.e. long-term rate control strategy, long-term rhythm control strategy, oral anticoagulation and AF catheter ablation). Significant differences were found between guidelines in the quality of evidence or level of evidence and on the strength of recommendations. Use of new anticoagulants and of new antiarrhythmic drug therapy is also discussed in the light of recent trial results. Whether multiplication of guidelines and differences in recommendation impact their implementation in clinical practice, remains to be assessed.