The American Heart Association, American College of Cardiology, and Heart Rhythm Society in collaboration with the Society of Thoracic Surgery have published an updated atrial fibrillation (AF) guideline. The new guideline has several important changes, including: New oral anticoagulants join the treatment options — along with warfarin, new options include dabigatran (Pradaxa), rivaroxaban (Xarelto), and apixaban (Eliquis). At the same time, the role of aspirin is reduced in the new guideline. The guideline also recommends a more comprehensive scoring system for AF risk, with the CHA2DS2-VASc scoring algorithm replacing the older CHADS2 scoring system. The newer scoring system gives points for congestive heart failure, hypertension, diabetes, vascular disease, age 65-74 years, and female sex, with two points for age ≥ 75 and prior stroke/TIA/thromboembolism. Catheter ablation has a more prominent role in the new guideline, especially as primary therapy in very symptomatic individuals. The use of radiofrequency ablation has become more commonplace since the last guideline in 2006. The new guideline was published simultaneously online in the Journal of the American College of Cardiology andCirculation (doi: 10.1016/j.jacc. 2014.03.021).
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