Early diagnosis and better rhythm management to improve outcomes in patients with atrial fibrillation: the 8th AFNET/EHRA consensus conference

Renate B Schnabel; Elena Andreassi Marinelli; Elena Arbelo; Giuseppe Boriani; Serge Boveda; Claire M Buckley; A John Camm; Barbara Casadei; Winnie Chua; Nikolaos Dagres; Mirko de Melis; Lien Desteghe; Søren Zöga Diederichsen; David Duncker; Lars Eckardt; Christoph Eisert; Daniel Engler; Larissa Fabritz; Ben Freedman; Ludovic Gillet; Andreas Goette; Eduard Guasch; Jesper Hastrup Svendsen; Stéphane N Hatem; Karl Georg Haeusler; Jeff S Healey; Hein Heidbuchel; Gerhard Hindricks; F D Richard Hobbs; Thomas Hübner; Dipak Kotecha; Michael Krekler; Christophe Leclercq; Thorsten Lewalter; Honghuang Lin; Dominik Linz; Gregory Y H Lip; Maja Lisa Løchen; Wim Lucassen; Katarzyna Malaczynska-Rajpold; Steffen Massberg; Jose L Merino; Ralf Meyer; Lluıs Mont; Michael C Myers; Lis Neubeck; Teemu Niiranen; Michael Oeff; Jonas Oldgren; Tatjana S Potpara; George Psaroudakis; Helmut Pürerfellner; Ursula Ravens; Michiel Rienstra; Lena Rivard; Daniel Scherr; Ulrich Schotten; Dipen Shah; Moritz F Sinner; Rüdiger Smolnik; Gerhard Steinbeck; Daniel Steven; Emma Svennberg; Dierk Thomas; Mellanie True Hills; Isabelle C van Gelder; Burcu Vardar; Elena Palà; Reza Wakili; Karl Wegscheider; Mattias Wieloch; Stephan Willems; Henning Witt; André Ziegler; Matthias Daniel Zink; Paulus Kirchhof

doi:10.1093/europace/euac062

Early diagnosis and better rhythm management to improve outcomes in patients with atrial fibrillation: the 8th AFNET/EHRA consensus conference

Europace. 2023 Feb 8;25(1):6-27. doi: 10.1093/europace/euac062.

Authors

Renate B Schnabel^{1

2

3}, Elena Andreassi Marinelli⁴, Elena Arbelo^{5

6

7}, Giuseppe Boriani⁸, Serge Boveda^{9

10}, Claire M Buckley¹¹, A John Camm¹², Barbara Casadei¹³, Winnie Chua¹⁴, Nikolaos Dagres¹⁵, Mirko de Melis¹⁶, Lien Desteghe^{17

18

19

20}, Søren Zöga Diederichsen²¹, David Duncker²², Lars Eckardt^{1

23}, Christoph Eisert²⁴, Daniel Engler^{2

3}, Larissa Fabritz^{1

2

3

14

25}, Ben Freedman²⁶, Ludovic Gillet²⁷, Andreas Goette^{1

28}, Eduard Guasch^{5

6

7}, Jesper Hastrup Svendsen^{21

29}, Stéphane N Hatem³⁰, Karl Georg Haeusler^{1

31}, Jeff S Healey³², Hein Heidbuchel^{17

18}, Gerhard Hindricks^{1

15}, F D Richard Hobbs³³, Thomas Hübner²⁴, Dipak Kotecha³⁴, Michael Krekler³⁵, Christophe Leclercq³⁶, Thorsten Lewalter^{1

37

38}, Honghuang Lin³⁹, Dominik Linz^{40

41}, Gregory Y H Lip^{42

43}, Maja Lisa Løchen⁴⁴, Wim Lucassen⁴⁵, Katarzyna Malaczynska-Rajpold⁴⁶, Steffen Massberg^{47

48}, Jose L Merino⁴⁹, Ralf Meyer⁵⁰, Lluıs Mont^{5

6

7}, Michael C Myers³⁵, Lis Neubeck⁴⁹, Teemu Niiranen^{50

51}, Michael Oeff¹, Jonas Oldgren⁵², Tatjana S Potpara⁵³, George Psaroudakis⁵⁴, Helmut Pürerfellner⁵⁵, Ursula Ravens^{1

56}, Michiel Rienstra⁵⁷, Lena Rivard⁵⁸, Daniel Scherr⁵⁹, Ulrich Schotten^{1

60}, Dipen Shah⁶¹, Moritz F Sinner^{1

45

46}, Rüdiger Smolnik⁴, Gerhard Steinbeck^{1

62}, Daniel Steven^{1

63}, Emma Svennberg⁶⁴, Dierk Thomas^{1

65

66

67}, Mellanie True Hills⁶⁸, Isabelle C van Gelder⁶⁹, Burcu Vardar⁵⁴, Elena Palà⁷⁰, Reza Wakili^{1

71}, Karl Wegscheider^{1

3

72}, Mattias Wieloch^{73

74}, Stephan Willems^{1

3

75}, Henning Witt⁷⁶, André Ziegler²⁷, Matthias Daniel Zink⁷⁷, Paulus Kirchhof^{1

2

3

14}

Affiliations

¹ Atrial Fibrillation Network (AFNET), Muenster, Germany.
² Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
³ German Centre for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany.
⁴ Daiichi Sankyo Europe, Munich, Germany.
⁵ Arrhythmia Section, Cardiology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
⁶ IDIBAPS, Institut d'Investigació August Pi i Sunyer, Barcelona, Spain.
⁷ CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain.
⁸ Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Polyclinic of Modena, Modena, Italy.
⁹ Cardiology-Heart Rhythm Management Department, Clinique Pasteur, 45 Avenue de Lombez, 31076 Toulouse, France.
¹⁰ Universiteit Ziekenhuis, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
¹¹ School of Public Health, University College Cork, Cork, Ireland.
¹² Cardiology Clinical Academic Group, Molecular and Clinical Sciences Institute, St. George's University of London, London, UK.
¹³ RDM, Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
¹⁴ Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
¹⁵ Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
¹⁶ Medtronic Bakken Research Center, Maastricht, The Netherlands.
¹⁷ Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium.
¹⁸ Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium.
¹⁹ Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
²⁰ Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium.
²¹ Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
²² Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
²³ Division of Electrophysiology, Department of Cardiology and Angiology, Münster, Germany.
²⁴ Preventicus, Jena, Germany.
²⁵ University Center of Cardiovascular Science Hamburg, Hamburg, Germany.
²⁶ Heart Research Institute, The University of Sydney, Sydney, Australia.
²⁷ Roche Diagnostics, Basel, Switzerland.
²⁸ St Vincenz Hospital, Paderborn, Germany.
²⁹ Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
³⁰ IHU ICAN, Sorbonne-Universite, Paris, France.
³¹ Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany.
³² Population Health Research Institute, McMaster University Hamilton, ON, Canada.
³³ Oxford Primary Care, University of Oxford, Oxford, UK.
³⁴ University of Birmingham & University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
³⁵ Bristol Myers Squibb, New York, NY, USA.
³⁶ Department of Cardiology, University Rennes, Rennes, France.
³⁷ Hospital Munich South, Department of Cardiology, Munich, Germany.
³⁸ Department of Cardiology, University of Bonn, Bonn, Germany.
³⁹ Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
⁴⁰ Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
⁴¹ Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
⁴² Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.
⁴³ Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
⁴⁴ Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
⁴⁵ Amsterdam UMC (location AMC), Department General Practice, Amsterdam, The Netherlands.
⁴⁶ Royal Brompton Hospital, London, UK.
⁴⁷ Department of Cardiology, University Hospital, LMU Munich, Munich, Germany.
⁴⁸ German Centre for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany.
⁴⁹ Arrhythmia & Robotic EP Unit, La Paz University Hospital, IDIPAZ, Madrid, Spain.
⁵⁰ Medtronic, Dublin, Ireland.
⁵¹ Centre for Cardiovascular Health Edinburgh Napier University, Edinburgh, UK.
⁵² University of Turku and Turku University Hospital, Turku, Finland.
⁵³ National Institute for Health and Welfare, Helsinki, Finland.
⁵⁴ Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
⁵⁵ School of Medicine, Belgrade University, Cardiology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia.
⁵⁶ Bayer AG, Leverkusen, Germany.
⁵⁷ Ordensklinikum Linz, Elisabethinen, Cardiological Department, Linz, Austria.
⁵⁸ Institute of Experimental Cardiovascular Medicine, University Hospital Freiburg, Freiburg, Germany.
⁵⁹ Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁶⁰ Montreal Heart Institute, University of Montreal, Montreal, Canada.
⁶¹ Division of Cardiology, Medical University of Graz, Graz, Austria.
⁶² MUMC+, Maastricht, The Netherlands.
⁶³ University Hospital of Geneva, Cardiac Electrophysiology Unit, Geneva, Switzerland.
⁶⁴ Center for Cardiology at Clinic Starnberg, Starnberg, Germany.
⁶⁵ University Hospital Cologne, Heart Center, Department of Electrophysiology, Cologne, Germany.
⁶⁶ Karolinska Institutet, Department of Medicine Huddinge, Karolinska University Hospital, Stockholm, Sweden.
⁶⁷ Department of Cardiology, Medical University Hospital, Heidelberg, Germany.
⁶⁸ HCR (Heidelberg Center for Heart Rhythm Disorders), Medical University Hospital Heidelberg, Heidelberg, Germany.
⁶⁹ DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany.
⁷⁰ StopAfib.org, American Foundation for Women's Health, Decatur, TX, USA.
⁷¹ Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands.
⁷² Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Autonomous University of Barcelona, Barcelona, Spain.
⁷³ Department of Cardiology and Vascular Medicine, Westgerman Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany.
⁷⁴ Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany.
⁷⁵ Department of Coagulation Disorders, Skane University Hospital, Lund University, Malmö, Sweden.
⁷⁶ Sanofi, Paris, France.
⁷⁷ Asklepios Hospital St Georg, Department of Cardiology and Internal Intensive Care Medicine, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany.

Abstract

Despite marked progress in the management of atrial fibrillation (AF), detecting AF remains difficult and AF-related complications cause unacceptable morbidity and mortality even on optimal current therapy. This document summarizes the key outcomes of the 8th AFNET/EHRA Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA). Eighty-three international experts met in Hamburg for 2 days in October 2021. Results of the interdisciplinary, hybrid discussions in breakout groups and the plenary based on recently published and unpublished observations are summarized in this consensus paper to support improved care for patients with AF by guiding prevention, individualized management, and research strategies. The main outcomes are (i) new evidence supports a simple, scalable, and pragmatic population-based AF screening pathway; (ii) rhythm management is evolving from therapy aimed at improving symptoms to an integrated domain in the prevention of AF-related outcomes, especially in patients with recently diagnosed AF; (iii) improved characterization of atrial cardiomyopathy may help to identify patients in need for therapy; (iv) standardized assessment of cognitive function in patients with AF could lead to improvement in patient outcomes; and (v) artificial intelligence (AI) can support all of the above aims, but requires advanced interdisciplinary knowledge and collaboration as well as a better medico-legal framework. Implementation of new evidence-based approaches to AF screening and rhythm management can improve outcomes in patients with AF. Additional benefits are possible with further efforts to identify and target atrial cardiomyopathy and cognitive impairment, which can be facilitated by AI.

Keywords: AFNET; Anticoagulation; Artificial intelligence; Atrial cardiomyopathy; Atrial fibrillation; Bleeding; Catheter ablation; Cognitive function; Consensus statement; Cost; Dementia; EHRA; Guidelines; Heart failure; Integrated care; Outcomes; Quality of care; Research; Research priorities; Rhythm management; Screening; Stroke; Technology.

MeSH terms

Artificial Intelligence
Atrial Fibrillation* / complications
Atrial Fibrillation* / diagnosis
Atrial Fibrillation* / therapy
Cognition
Consensus
Early Diagnosis
Humans
Stroke* / prevention & control

Grants and funding

U01 AG068221/AG/NIA NIH HHS/United States