Interpretation of Chinese guidelines on diagnosis and management of atrial fibrillation: Emergency management_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

TIAN Weifan ¹ , LI Dongze ¹ , ZHANG Haihong ¹ , LIAO Xiaoyang ² , ZENG Rui ³ ,  WAN Zhi ¹

1. Department of Emergency, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Department of General Practice, International Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
3. Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

WAN Zhi, Email: wanzhi4115@wchscu.cn

Keywords：

Atrial fibrillation; emergency; rhythm control; rate control

DOI：

10.7507/1007-4848.202308014

Video：

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The Chinese Guidelines on Diagnosis and Management of Atrial Fibrillation, jointly formulated by the Chinese Society of Cardiology, Chinese Medical Association and the Heart Rhythm Committee of Chinese Society of Biomedical Engineering, was first released on June 15, 2023. The guidelines elaborate the various aspects of atrial fibrillation management, in which emergency management of atrial fibrillation is also an integral part. This article interpreted the emergency management part in the guidelines in detail by reviewing relevant literature.

Citation： TIAN Weifan, LI Dongze, ZHANG Haihong, LIAO Xiaoyang, ZENG Rui, WAN Zhi. Interpretation of Chinese guidelines on diagnosis and management of atrial fibrillation: Emergency management. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(10): 1377-1383. doi: 10.7507/1007-4848.202308014 Copy

1.	Andrade J, Khairy P, Dobrev D, et al. The clinical profile and pathophysiology of atrial fibrillation: Relationships among clinical features, epidemiology, and mechanisms. Circ Res, 2014, 114(9): 1453-1468.
2.	Varona M, Coll-Vinent B, Martín A, et al. Factors associated with poor prognosis in patients with atrial fibrillation: An emergency department perspective the EMERG-AF study. Am J Emerg Med, 2021, 50: 270-277.
3.	中华医学会心血管病学分会, 中国生物医学工程学会心律分会. 心房颤动诊断和治疗中国指南. 中华心血管病杂志, 2023, 51(6): 572-618.
4.	黄从新, 张澍, 黄德嘉, 等. 心房颤动: 目前的认识和治疗建议. 中国心脏起搏与心电生理杂志, 2015, 29(5): 377-434.
5.	黄从新, 张澍, 黄德嘉, 等. 心房颤动: 目前的认识和治疗建议. 中国心脏起搏与心电生理杂志, 2018, 32(4): 315-368.
6.	中华医学会心电生理和起搏分会, 中国医师协会心律学专业委员会, 中国房颤中心联盟心房颤动防治专家工作委员会. 心房颤动: 目前的认识和治疗建议 (2021). 中华心律失常学杂志, 2022, 26(1): 15-88.
7.	Wazni OM, Beheiry S, Fahmy T, et al. Atrial fibrillation ablation in patients with therapeutic international normalized ratio: Comparison of strategies of anticoagulation management in the periprocedural period. Circulation, 2007, 116(22): 2531-2534.
8.	Sohns C, Marrouche NF. Atrial fibrillation and cardiac fibrosis. Eur Heart J, 2020, 41(10): 1123-1131.
9.	Sagris M, Vardas EP, Theofilis P, et al. Atrial fibrillation: Pathogenesis, predisposing factors, and genetics. Int J Mol Sci, 2021, 23(1): 6.
10.	Glaus T, Schellenberg S, Lang J. Cardiogenic and non-cardiogenic pulmonary edema: Pathomechanisms and causes. Schweiz Arch Tierheilkd, 2010, 152(7): 311-317.
11.	King KC, Goldstein S. Congestive Heart Failure and Pulmonary Edema. StatPearls Publishing LLC, 2023.
12.	Adgey AA, Walsh SJ. Theory and practice of defibrillation: Atrial fibrillation and DC conversion. Heart, 2004, 90(12): 1493-1498.
13.	Hindricks G, Potpara T, Dagres N, et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J, 2021, 42(5): 373-498.
14.	Stiell IG, Sivilotti MLA, Taljaard M, et al. Electrical versus pharmacological cardioversion for emergency department patients with acute atrial fibrillation (RAFF2): A partial factorial randomised trial. Lancet, 2020, 395(10221): 339-349.
15.	MacKenzie M, Stewart D, Hall C. Electrical or pharmacologic cardioversion for atrial fibrillation in the ED? CJEM, 2021, 23(1): 32-33.
16.	Kim SS, Knight BP. Electrical and pharmacologic cardioversion for atrial fibrillation. Med Clin North Am, 2008, 92(1): 101-120.
17.	January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in collaboration with the Society of Thoracic Surgeons. Circulation, 2019, 140(2): e125-e151.
18.	Andrade JG, Aguilar M, Atzema C, et al. The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive guidelines for the management of atrial fibrillation. Can J Cardiol, 2020, 36(12): 1847-1948.
19.	Kirkland S, Stiell I, AlShawabkeh T, et al. The efficacy of pad placement for electrical cardioversion of atrial fibrillation/flutter: A systematic review. Acad Emerg Med, 2014, 21(7): 717-726.
20.	Sims JJ, Miller AW, Ujhelyi MR. Disparate effects of biphasic and monophasic shocks on postshock refractory period dispersion. Am J Physiol, 1998, 274(6): H1943-H1949.
21.	Mittal S, Ayati S, Stein KM, et al. Transthoracic cardioversion of atrial fibrillation: Comparison of rectilinear biphasic versus damped sine wave monophasic shocks. Circulation, 2000, 101(11): 1282-1287.
22.	Scholten M, Szili-Torok T, Klootwijk P, et al. Comparison of monophasic and biphasic shocks for transthoracic cardioversion of atrial fibrillation. Heart, 2003, 89(9): 1032-1034.
23.	Inácio JF, da Rosa Mdos S, Shah J, et al. Monophasic and biphasic shock for transthoracic conversion of atrial fibrillation: Systematic review and network meta-analysis. Resuscitation, 2016, 100: 66-75.
24.	Nguyen ST, Belley-Côté EP, Ibrahim O, et al. Techniques improving electrical cardioversion success for patients with atrial fibrillation: A systematic review and meta-analysis. Europace, 2023, 25(2): 318-330.
25.	Schmidt AS, Lauridsen KG, Torp P, et al. Maximum-fixed energy shocks for cardioverting atrial fibrillation. Eur Heart J, 2020, 41(5): 626-631.
26.	Climent VE, Marin F, Mainar L, et al. Effects of pretreatment with intravenous flecainide on efficacy of external cardioversion of persistent atrial fibrillation. Pacing Clin Electrophysiol, 2004, 27(3): 368-372.
27.	Toner L, Proimos H, Scully T, et al. Late recurrence of atrial fibrillation and flutter in patients referred for elective electrical cardioversion. Kardiologiia, 2023, 63(1): 54-59.
28.	Capucci A, Villani GQ, Aschieri D, et al. Oral amiodarone increases the efficacy of direct-current cardioversion in restoration of sinus rhythm in patients with chronic atrial fibrillation. Eur Heart J, 2000, 21(1): 66-73.
29.	Um KJ, McIntyre WF, Healey JS, et al. Pre- and post-treatment with amiodarone for elective electrical cardioversion of atrial fibrillation: A systematic review and meta-analysis. Europace, 2019, 21(6): 856-863.
30.	Boriani G, Biffi M, Capucci A, et al. Favorable effects of flecainide in transvenous internal cardioversion of atrial fibrillation. J Am Coll Cardiol, 1999, 33(2): 333-341.
31.	Velázquez-Rodríguez E, Pérez-Sandoval HA, Rangel-Rojo FJ. Orthogonal electrical cardioversion in atrial fibrillation refractory to biphasic shocks: A case series. Eur Heart J Case Rep, 2020, 4(6): 1-5.
32.	Hawks MK, Paul MLB, Malu OO. Sinus node dysfunction. Am Fam Physician, 2021, 104(2): 179-85.
33.	Van Gelder IC, Groenveld HF, Crijns HJ, et al. Lenient versus strict rate control in patients with atrial fibrillation. N Engl J Med, 2010, 362(15): 1363-1373.
34.	Smit MD, Crijns HJ, Tijssen JG, et al. Effect of lenient versus strict rate control on cardiac remodeling in patients with atrial fibrillation data of the RACEⅡ(RAte Control Efficacy in permanent atrial fibrillationⅡ) study. J Am Coll Cardiol, 2011, 58(9): 942-949.
35.	Groenveld HF, Crijns HJ, Van den Berg MP, et al. The effect of rate control on quality of life in patients with permanent atrial fibrillation: Data from the RACEⅡ(RAte Control Efficacy in permanent atrial fibrillationⅡ) study. J Am Coll Cardiol, 2011, 58(17): 1795-1803.
36.	Groenveld HF, Tijssen JG, Crijns HJ, et al. Rate control efficacy in permanent atrial fibrillation: Successful and failed strict rate control against a background of lenient rate control: Data from RACE Ⅱ(RAte Control Efficacy in permanent atrial fibrillation). J Am Coll Cardiol, 2013, 61(7): 741-748.
37.	Ai S, Zhang J, Zhao G, et al. Causal associations of short and long sleep durations with 12 cardiovascular diseases: Linear and nonlinear Mendelian randomization analyses in UK Biobank. Eur Heart J, 2021, 42(34): 3349-3357.
38.	Nattel S, Heijman J, Zhou L, et al. Molecular basis of atrial fibrillation pathophysiology and therapy: A translational perspective. Circ Res, 2020, 127(1): 51-72.
39.	Aune D, Mahamat-Saleh Y, Kobeissi E, et al. Blood pressure, hypertension and the risk of atrial fibrillation: A systematic review and meta-analysis of cohort studies. Eur J Epidemiol, 2023, 38(2): 145-178.
40.	Zhao M, Song L, Zhao Q, et al. Elevated levels of body mass index and waist circumference, but not high variability, are associated with an increased risk of atrial fibrillation. BMC Med, 2022, 20(1): 215.
41.	Dublin S, Glazer NL, Smith NL, et al. Diabetes mellitus, glycemic control, and risk of atrial fibrillation. J Gen Intern Med, 2010, 25(8): 853-858.
42.	Han M, Lee SR, Choi EK, et al. Habitual alcohol intake and risk of atrial fibrillation in young adults in Korea. JAMA Netw Open, 2022, 5(9): e2229799.
43.	Chamberlain AM, Agarwal SK, Folsom AR, et al. Smoking and incidence of atrial fibrillation: Results from the Atherosclerosis Risk in Communities (ARIC) study. Heart Rhythm, 2011, 8(8): 1160-1166.
44.	Groh CA, Vittinghoff E, Benjamin EJ, et al. Childhood tobacco smoke exposure and risk of atrial fibrillation in adulthood. J Am Coll Cardiol, 2019, 74(13): 1658-1664.
45.	Klein Klouwenberg PM, Frencken JF, Kuipers S, et al. Incidence, predictors, and outcomes of new-onset atrial fibrillation in critically ill patients with sepsis. A cohort study. Am J Respir Crit Care Med, 2017, 195(2): 205-211.
46.	Rowin EJ, Hausvater A, Link MS, et al. Clinical profile and consequences of atrial fibrillation in hypertrophic cardiomyopathy. Circulation, 2017, 136(25): 2420-2436.
47.	Middeldorp ME, Pathak RK, Meredith M, et al. PREVEntion and regReSsive effect of weight-loss and risk factor modification on atrial fibrillation: The REVERSE-AF study. Europace, 2018, 20(12): 1929-1935.
48.	Voskoboinik A, Kalman JM, De Silva A, et al. Alcohol abstinence in drinkers with atrial fibrillation. N Engl J Med, 2020, 382(1): 20-28.
49.	Li L, Wang ZW, Li J, et al. Efficacy of catheter ablation of atrial fibrillation in patients with obstructive sleep apnoea with and without continuous positive airway pressure treatment: A meta-analysis of observational studies. Europace, 2014, 16(9): 1309-1314.

1. Andrade J, Khairy P, Dobrev D, et al. The clinical profile and pathophysiology of atrial fibrillation: Relationships among clinical features, epidemiology, and mechanisms. Circ Res, 2014, 114(9): 1453-1468.
2. Varona M, Coll-Vinent B, Martín A, et al. Factors associated with poor prognosis in patients with atrial fibrillation: An emergency department perspective the EMERG-AF study. Am J Emerg Med, 2021, 50: 270-277.
3. 中华医学会心血管病学分会, 中国生物医学工程学会心律分会. 心房颤动诊断和治疗中国指南. 中华心血管病杂志, 2023, 51(6): 572-618.
4. 黄从新, 张澍, 黄德嘉, 等. 心房颤动: 目前的认识和治疗建议. 中国心脏起搏与心电生理杂志, 2015, 29(5): 377-434.
5. 黄从新, 张澍, 黄德嘉, 等. 心房颤动: 目前的认识和治疗建议. 中国心脏起搏与心电生理杂志, 2018, 32(4): 315-368.
6. 中华医学会心电生理和起搏分会, 中国医师协会心律学专业委员会, 中国房颤中心联盟心房颤动防治专家工作委员会. 心房颤动: 目前的认识和治疗建议 (2021). 中华心律失常学杂志, 2022, 26(1): 15-88.
7. Wazni OM, Beheiry S, Fahmy T, et al. Atrial fibrillation ablation in patients with therapeutic international normalized ratio: Comparison of strategies of anticoagulation management in the periprocedural period. Circulation, 2007, 116(22): 2531-2534.
8. Sohns C, Marrouche NF. Atrial fibrillation and cardiac fibrosis. Eur Heart J, 2020, 41(10): 1123-1131.
9. Sagris M, Vardas EP, Theofilis P, et al. Atrial fibrillation: Pathogenesis, predisposing factors, and genetics. Int J Mol Sci, 2021, 23(1): 6.
10. Glaus T, Schellenberg S, Lang J. Cardiogenic and non-cardiogenic pulmonary edema: Pathomechanisms and causes. Schweiz Arch Tierheilkd, 2010, 152(7): 311-317.
11. King KC, Goldstein S. Congestive Heart Failure and Pulmonary Edema. StatPearls Publishing LLC, 2023.
12. Adgey AA, Walsh SJ. Theory and practice of defibrillation: Atrial fibrillation and DC conversion. Heart, 2004, 90(12): 1493-1498.
13. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J, 2021, 42(5): 373-498.
14. Stiell IG, Sivilotti MLA, Taljaard M, et al. Electrical versus pharmacological cardioversion for emergency department patients with acute atrial fibrillation (RAFF2): A partial factorial randomised trial. Lancet, 2020, 395(10221): 339-349.
15. MacKenzie M, Stewart D, Hall C. Electrical or pharmacologic cardioversion for atrial fibrillation in the ED? CJEM, 2021, 23(1): 32-33.
16. Kim SS, Knight BP. Electrical and pharmacologic cardioversion for atrial fibrillation. Med Clin North Am, 2008, 92(1): 101-120.
17. January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in collaboration with the Society of Thoracic Surgeons. Circulation, 2019, 140(2): e125-e151.
18. Andrade JG, Aguilar M, Atzema C, et al. The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive guidelines for the management of atrial fibrillation. Can J Cardiol, 2020, 36(12): 1847-1948.
19. Kirkland S, Stiell I, AlShawabkeh T, et al. The efficacy of pad placement for electrical cardioversion of atrial fibrillation/flutter: A systematic review. Acad Emerg Med, 2014, 21(7): 717-726.
20. Sims JJ, Miller AW, Ujhelyi MR. Disparate effects of biphasic and monophasic shocks on postshock refractory period dispersion. Am J Physiol, 1998, 274(6): H1943-H1949.
21. Mittal S, Ayati S, Stein KM, et al. Transthoracic cardioversion of atrial fibrillation: Comparison of rectilinear biphasic versus damped sine wave monophasic shocks. Circulation, 2000, 101(11): 1282-1287.
22. Scholten M, Szili-Torok T, Klootwijk P, et al. Comparison of monophasic and biphasic shocks for transthoracic cardioversion of atrial fibrillation. Heart, 2003, 89(9): 1032-1034.
23. Inácio JF, da Rosa Mdos S, Shah J, et al. Monophasic and biphasic shock for transthoracic conversion of atrial fibrillation: Systematic review and network meta-analysis. Resuscitation, 2016, 100: 66-75.
24. Nguyen ST, Belley-Côté EP, Ibrahim O, et al. Techniques improving electrical cardioversion success for patients with atrial fibrillation: A systematic review and meta-analysis. Europace, 2023, 25(2): 318-330.
25. Schmidt AS, Lauridsen KG, Torp P, et al. Maximum-fixed energy shocks for cardioverting atrial fibrillation. Eur Heart J, 2020, 41(5): 626-631.
26. Climent VE, Marin F, Mainar L, et al. Effects of pretreatment with intravenous flecainide on efficacy of external cardioversion of persistent atrial fibrillation. Pacing Clin Electrophysiol, 2004, 27(3): 368-372.
27. Toner L, Proimos H, Scully T, et al. Late recurrence of atrial fibrillation and flutter in patients referred for elective electrical cardioversion. Kardiologiia, 2023, 63(1): 54-59.
28. Capucci A, Villani GQ, Aschieri D, et al. Oral amiodarone increases the efficacy of direct-current cardioversion in restoration of sinus rhythm in patients with chronic atrial fibrillation. Eur Heart J, 2000, 21(1): 66-73.
29. Um KJ, McIntyre WF, Healey JS, et al. Pre- and post-treatment with amiodarone for elective electrical cardioversion of atrial fibrillation: A systematic review and meta-analysis. Europace, 2019, 21(6): 856-863.
30. Boriani G, Biffi M, Capucci A, et al. Favorable effects of flecainide in transvenous internal cardioversion of atrial fibrillation. J Am Coll Cardiol, 1999, 33(2): 333-341.
31. Velázquez-Rodríguez E, Pérez-Sandoval HA, Rangel-Rojo FJ. Orthogonal electrical cardioversion in atrial fibrillation refractory to biphasic shocks: A case series. Eur Heart J Case Rep, 2020, 4(6): 1-5.
32. Hawks MK, Paul MLB, Malu OO. Sinus node dysfunction. Am Fam Physician, 2021, 104(2): 179-85.
33. Van Gelder IC, Groenveld HF, Crijns HJ, et al. Lenient versus strict rate control in patients with atrial fibrillation. N Engl J Med, 2010, 362(15): 1363-1373.
34. Smit MD, Crijns HJ, Tijssen JG, et al. Effect of lenient versus strict rate control on cardiac remodeling in patients with atrial fibrillation data of the RACEⅡ(RAte Control Efficacy in permanent atrial fibrillationⅡ) study. J Am Coll Cardiol, 2011, 58(9): 942-949.
35. Groenveld HF, Crijns HJ, Van den Berg MP, et al. The effect of rate control on quality of life in patients with permanent atrial fibrillation: Data from the RACEⅡ(RAte Control Efficacy in permanent atrial fibrillationⅡ) study. J Am Coll Cardiol, 2011, 58(17): 1795-1803.
36. Groenveld HF, Tijssen JG, Crijns HJ, et al. Rate control efficacy in permanent atrial fibrillation: Successful and failed strict rate control against a background of lenient rate control: Data from RACE Ⅱ(RAte Control Efficacy in permanent atrial fibrillation). J Am Coll Cardiol, 2013, 61(7): 741-748.
37. Ai S, Zhang J, Zhao G, et al. Causal associations of short and long sleep durations with 12 cardiovascular diseases: Linear and nonlinear Mendelian randomization analyses in UK Biobank. Eur Heart J, 2021, 42(34): 3349-3357.
38. Nattel S, Heijman J, Zhou L, et al. Molecular basis of atrial fibrillation pathophysiology and therapy: A translational perspective. Circ Res, 2020, 127(1): 51-72.
39. Aune D, Mahamat-Saleh Y, Kobeissi E, et al. Blood pressure, hypertension and the risk of atrial fibrillation: A systematic review and meta-analysis of cohort studies. Eur J Epidemiol, 2023, 38(2): 145-178.
40. Zhao M, Song L, Zhao Q, et al. Elevated levels of body mass index and waist circumference, but not high variability, are associated with an increased risk of atrial fibrillation. BMC Med, 2022, 20(1): 215.
41. Dublin S, Glazer NL, Smith NL, et al. Diabetes mellitus, glycemic control, and risk of atrial fibrillation. J Gen Intern Med, 2010, 25(8): 853-858.
42. Han M, Lee SR, Choi EK, et al. Habitual alcohol intake and risk of atrial fibrillation in young adults in Korea. JAMA Netw Open, 2022, 5(9): e2229799.
43. Chamberlain AM, Agarwal SK, Folsom AR, et al. Smoking and incidence of atrial fibrillation: Results from the Atherosclerosis Risk in Communities (ARIC) study. Heart Rhythm, 2011, 8(8): 1160-1166.
44. Groh CA, Vittinghoff E, Benjamin EJ, et al. Childhood tobacco smoke exposure and risk of atrial fibrillation in adulthood. J Am Coll Cardiol, 2019, 74(13): 1658-1664.
45. Klein Klouwenberg PM, Frencken JF, Kuipers S, et al. Incidence, predictors, and outcomes of new-onset atrial fibrillation in critically ill patients with sepsis. A cohort study. Am J Respir Crit Care Med, 2017, 195(2): 205-211.
46. Rowin EJ, Hausvater A, Link MS, et al. Clinical profile and consequences of atrial fibrillation in hypertrophic cardiomyopathy. Circulation, 2017, 136(25): 2420-2436.
47. Middeldorp ME, Pathak RK, Meredith M, et al. PREVEntion and regReSsive effect of weight-loss and risk factor modification on atrial fibrillation: The REVERSE-AF study. Europace, 2018, 20(12): 1929-1935.
48. Voskoboinik A, Kalman JM, De Silva A, et al. Alcohol abstinence in drinkers with atrial fibrillation. N Engl J Med, 2020, 382(1): 20-28.
49. Li L, Wang ZW, Li J, et al. Efficacy of catheter ablation of atrial fibrillation in patients with obstructive sleep apnoea with and without continuous positive airway pressure treatment: A meta-analysis of observational studies. Europace, 2014, 16(9): 1309-1314.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Interpretation of Chinese guidelines on diagnosis and management of atrial fibrillation: Emergency management

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