Comments on the 2024 ESC guidelines for the management of atrial fibrillation

Abstract

The new version of the European Society of Cardiology clinical practice guidelines on atrial fibrillation (AF) provides a comprehensive review of the state of the art in the diagnosis, prevention, and treatment of AF. The most relevant messages (figure 1) include a new general management scheme, called AF-CARE, which is notable for its comprehensive and multidisciplinary approach (focused on the detection and treatment of risk factors), prioritizing the reduction in symptoms and the prevention of thromboembolism, within a clinical pathway that includes periodic re-evaluation. In addition, the guidelines emphasize the need to involve patients—and society as a whole—in the management of AF, avoiding inequities due to gender, race, or social status. Safety remains a priority, requiring careful use of therapeutic tools that must be evaluated periodically to avoid undesirable effects. Below is a detailed and critical commentary on the novel features, limitations, and implications of these guidelines.