PDF(Pubmed)
Abstract：
OBJECTIVE: Although guidelines for the management of atrial fibrillation (AF) are regularly published, many controversial issues remain, limiting their implementation. We aim to describe current clinical practice among European Heart Rhythm Association (EHRA) community according to last guidelines.
RESULTS: A 30 multiple-choice questionnaire covering the most controversial topics related to AF management was distributed through the EHRA Research Network, National Societies, and social media between January and February 2023. One hundred and eighty-one physicians responded the survey, 61% from university hospitals. Atrial fibrillation screening in high-risk patients is regularly performed by 57%. Only 42% has access to at least one programme aiming at diagnosing/managing comorbidities and lifestyle modifications, with marked heterogeneity between countries. Direct oral anticoagulants are the preferred antithrombotic (97%). Rhythm control is the preferred strategy in most AF phenotypes: symptomatic vs. asymptomatic paroxysmal AF (97% vs. 77%), low vs. high risk for recurrence persistent AF (90% vs. 72%), and permanent AF (20%). I-C drugs and amiodarone are preferred while dronedarone and sotalol barely used. Ablation is the first-line therapy for symptomatic paroxysmal AF (69%) and persistent AF with markers of atrial disease (57%) and is performed independently of symptoms by 15%. In persistent AF, 68% performs only pulmonary vein isolation and 32% also additional lesions.
CONCLUSIONS: There is marked heterogeneity in AF management and limited accordance to last guidelines in the EHRA community. Most of the discrepancies are related to the main controversial issues, such as those related to AF screening, management of comorbidities, pharmacological treatment, and ablation strategy.
RESULTS: A 30 multiple-choice questionnaire covering the most controversial topics related to AF management was distributed through the EHRA Research Network, National Societies, and social media between January and February 2023. One hundred and eighty-one physicians responded the survey, 61% from university hospitals. Atrial fibrillation screening in high-risk patients is regularly performed by 57%. Only 42% has access to at least one programme aiming at diagnosing/managing comorbidities and lifestyle modifications, with marked heterogeneity between countries. Direct oral anticoagulants are the preferred antithrombotic (97%). Rhythm control is the preferred strategy in most AF phenotypes: symptomatic vs. asymptomatic paroxysmal AF (97% vs. 77%), low vs. high risk for recurrence persistent AF (90% vs. 72%), and permanent AF (20%). I-C drugs and amiodarone are preferred while dronedarone and sotalol barely used. Ablation is the first-line therapy for symptomatic paroxysmal AF (69%) and persistent AF with markers of atrial disease (57%) and is performed independently of symptoms by 15%. In persistent AF, 68% performs only pulmonary vein isolation and 32% also additional lesions.
CONCLUSIONS: There is marked heterogeneity in AF management and limited accordance to last guidelines in the EHRA community. Most of the discrepancies are related to the main controversial issues, such as those related to AF screening, management of comorbidities, pharmacological treatment, and ablation strategy.
摘要：
目的：虽然房颤（AF）的管理指南定期出版，许多有争议的问题仍然存在，限制其实施。我们旨在根据最新指南描述欧洲心律（EHRA）社区的当前临床实践。
方法：通过EHRA研究网络分发了30份多项选择问卷，涵盖了与房颤管理相关的最有争议的主题。2023年1月至2月之间的国家红会和社交媒体。
结果：181名医生回答了调查，61%来自大学医院。57％的高危患者定期进行房颤筛查。只有42％的人可以访问至少一个旨在诊断/管理合并症和生活方式改变的程序。国家之间存在明显的异质性。直接口服抗凝剂是优选的抗血栓形成药物(97%)。在大多数房颤表型中，节律控制是首选策略：有症状与无症状阵发性房颤（97%与77%），复发持续性房颤的低与高风险（90％vs72％），永久性房颤（20%）。优选I-C药物和胺碘酮，而决奈达隆和索他洛尔几乎不使用。消融是有症状的阵发性房颤(69%)和有心房疾病标记物的持续性房颤(57%)的一线治疗方法,并独立于症状进行15%。在持续性房颤中,68%的人只进行肺静脉隔离，32%的人还进行了额外的损伤。
结论：根据EHRA社区的最新指南，房颤管理存在明显的异质性。大部分差异与主要争议问题有关,例如与房颤筛查有关的那些，合并症的管理，药物治疗,和消融策略。
方法：通过EHRA研究网络分发了30份多项选择问卷，涵盖了与房颤管理相关的最有争议的主题。2023年1月至2月之间的国家红会和社交媒体。
结果：181名医生回答了调查，61%来自大学医院。57％的高危患者定期进行房颤筛查。只有42％的人可以访问至少一个旨在诊断/管理合并症和生活方式改变的程序。国家之间存在明显的异质性。直接口服抗凝剂是优选的抗血栓形成药物(97%)。在大多数房颤表型中，节律控制是首选策略：有症状与无症状阵发性房颤（97%与77%），复发持续性房颤的低与高风险（90％vs72％），永久性房颤（20%）。优选I-C药物和胺碘酮，而决奈达隆和索他洛尔几乎不使用。消融是有症状的阵发性房颤(69%)和有心房疾病标记物的持续性房颤(57%)的一线治疗方法,并独立于症状进行15%。在持续性房颤中,68%的人只进行肺静脉隔离，32%的人还进行了额外的损伤。
结论：根据EHRA社区的最新指南，房颤管理存在明显的异质性。大部分差异与主要争议问题有关,例如与房颤筛查有关的那些，合并症的管理，药物治疗,和消融策略。
