Rhythm Management of the Atrial Fibrillation Patient: Practical Implementation of the 2012 ESC Guidelines.

A symposium at the 2014 European Society of Cardiology (ESC) congress reviewed the 2012 update of the ESC guideline on rhythm management of atrial fibrillation (AF) patients. The guidelines now include catheter ablation of AF as first-line therapy in selected patients with symptomatic, paroxysmal AF. A panel comprising electrophysiologists and cardiologists discussed four clinical cases that illustrated the challenges faced in the day-to-day treatment of AF patients and how these guidelines can help inform treatment decisions. Among the key discussions were the importance of early treatment of AF and the dilemma faced in treating AF patients with recently implanted stent, where the risk of stroke must be balanced against the risk of stent thrombosis. The panel considered that among selected patients with paroxysmal AF and no structural heart disease, catheter ablation is reasonable as first-line therapy.