2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Overview

Journal Circulation

Specialty Cardiology & Vascular Diseases

Date 2023 Nov 30

PMID 38033089

Authors

Jose A Joglar

Mina K Chung

Anastasia L Armbruster

Emelia J Benjamin

Janice Y Chyou

Edmond M Cronin

Anita Deswal

Lee L Eckhardt

Zachary D Goldberger

Rakesh Gopinathannair

Bulent Gorenek

Paul L Hess

Mark Hlatky

Gail Hogan

Chinwe Ibeh

Julia H Indik

Kazuhiko Kido

Fred Kusumoto

Mark S Link

Kathleen T Linta

Gregory M Marcus

Patrick M McCarthy

Nimesh Patel

Kristen K Patton

Marco V Perez

Jonathan P Piccini

Andrea M Russo

Prashanthan Sanders

Megan M Streur

Kevin L Thomas

Sabrina Times

James E Tisdale

Anne Marie Valente

David R Van Wagoner

Affiliations

Soon will be listed here.

Abstract

Aim: The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation.

Methods: A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate.

Structure: Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.

Citing Articles

Antithrombotic therapy in atrial flutter: To anticoagulate or not, that is the question.

Wesolek F, Szyszka P, Cichon M, Mizia-Stec K, Wybraniec M Heart Rhythm O2. 2025; 6(1):86-96.

PMID: 40060166 PMC: 11885911. DOI: 10.1016/j.hroo.2024.11.003.

Design and Evaluation of ACAFiB-APP, a clinical decision support system for anticoagulant considerations in patients with atrial fibrillation.

Ansari R, Rezayi S, Safaei A, Mollazadeh R, Rezaei E, Mafinejad M BMC Cardiovasc Disord. 2025; 25(1):166.

PMID: 40057691 PMC: 11889798. DOI: 10.1186/s12872-025-04615-w.

Impact of catheter ablation on atrial fibrillation outcomes in various cardiomyopathies: findings from LGE-MRI quantified atrial fibrosis analysis.

Kassar A, Chamoun N, Haykal R, Chahine Y, Al Yasiri H, Hensley T J Interv Card Electrophysiol. 2025; .

PMID: 40056366 DOI: 10.1007/s10840-025-02027-6.

Precision medicine in the management of cardiac arrhythmias.

Wiedmann F, Schmidt C Herz. 2025; .

PMID: 40056164 DOI: 10.1007/s00059-025-05298-x.

Elucidating the Linkage Between Obesity-Related Body Fat Indicators and Atrial Fibrillation: Supported by Evidence From Mendelian Randomization and Mediation Analyses.

Wang J, Zhou S, Xie X, Liu W Clin Cardiol. 2025; 48(3):e70103.

PMID: 40045506 PMC: 11882476. DOI: 10.1002/clc.70103.

References

Ganesan A, Brooks A, Roberts-Thomson K, Lau D, Kalman J, Sanders P . Role of AV nodal ablation in cardiac resynchronization in patients with coexistent atrial fibrillation and heart failure a systematic review. J Am Coll Cardiol. 2012; 59(8):719-26. DOI: 10.1016/j.jacc.2011.10.891. View

Labombarda F, Hamilton R, Shohoudi A, Aboulhosn J, Broberg C, Chaix M . Increasing Prevalence of Atrial Fibrillation and Permanent Atrial Arrhythmias in Congenital Heart Disease. J Am Coll Cardiol. 2017; 70(7):857-865. DOI: 10.1016/j.jacc.2017.06.034. View

Kuck K, Merkely B, Zahn R, Arentz T, Seidl K, Schluter M . Catheter Ablation Versus Best Medical Therapy in Patients With Persistent Atrial Fibrillation and Congestive Heart Failure: The Randomized AMICA Trial. Circ Arrhythm Electrophysiol. 2019; 12(12):e007731. DOI: 10.1161/CIRCEP.119.007731. View

Bazal P, Gea A, Navarro A, Salas-Salvado J, Corella D, Alonso-Gomez A . Caffeinated coffee consumption and risk of atrial fibrillation in two Spanish cohorts. Eur J Prev Cardiol. 2021; 28(6):648-657. DOI: 10.1177/2047487320909065. View

Ha J, Neuen B, Cheng L, Jun M, Toyama T, Gallagher M . Benefits and Harms of Oral Anticoagulant Therapy in Chronic Kidney Disease: A Systematic Review and Meta-analysis. Ann Intern Med. 2019; 171(3):181-189. DOI: 10.7326/M19-0087. View

El-Assaad I, Al-Kindi S, Abraham J, Sanatani S, Bradley D, Halsey C . Use of dofetilide in adult patients with atrial arrhythmias and congenital heart disease: A PACES collaborative study. Heart Rhythm. 2016; 13(10):2034-9. DOI: 10.1016/j.hrthm.2016.07.016. View

Bansal N, Fan D, Hsu C, Ordonez J, Marcus G, Go A . Incident atrial fibrillation and risk of end-stage renal disease in adults with chronic kidney disease. Circulation. 2013; 127(5):569-74. PMC: 3676734. DOI: 10.1161/CIRCULATIONAHA.112.123992. View

Ma X, Boldt L, Zhang Y, Zhu M, Hu B, Parwani A . Clinical Relevance of Left Atrial Strain to Predict Recurrence of Atrial Fibrillation after Catheter Ablation: A Meta-Analysis. Echocardiography. 2016; 33(5):724-33. DOI: 10.1111/echo.13184. View

Nakagawa H, Jackman W, Scherlag B, Lazzara R . Pulmonary vein isolation during atrial fibrillation: insight into the mechanism of pulmonary vein firing. J Cardiovasc Electrophysiol. 2003; 14(3):261-2. DOI: 10.1046/j.1540-8167.2003.03002.x. View

10.

Malik V, Mishima R, Elliott A, Lau D, Sanders P . The "Road" to Atrial Fibrillation: The Role of the Cardiac Autonomic Nervous System. J Atr Fibrillation. 2020; 13(1):2400. PMC: 7533139. DOI: 10.4022/jafib.2400. View

11.

Reimold S, Cantillon C, Friedman P, Antman E . Propafenone versus sotalol for suppression of recurrent symptomatic atrial fibrillation. Am J Cardiol. 1993; 71(7):558-63. DOI: 10.1016/0002-9149(93)90511-a. View

12.

Viles-Gonzalez J, Kar S, Douglas P, Dukkipati S, Feldman T, Horton R . The clinical impact of incomplete left atrial appendage closure with the Watchman Device in patients with atrial fibrillation: a PROTECT AF (Percutaneous Closure of the Left Atrial Appendage Versus Warfarin Therapy for Prevention of Stroke in.... J Am Coll Cardiol. 2012; 59(10):923-9. DOI: 10.1016/j.jacc.2011.11.028. View

13.

Tops L, Schalij M, Holman E, van Erven L, van der Wall E, Bax J . Right ventricular pacing can induce ventricular dyssynchrony in patients with atrial fibrillation after atrioventricular node ablation. J Am Coll Cardiol. 2006; 48(8):1642-8. DOI: 10.1016/j.jacc.2006.05.072. View

14.

Delle Karth G, Geppert A, Neunteufl T, Priglinger U, Haumer M, Gschwandtner M . Amiodarone versus diltiazem for rate control in critically ill patients with atrial tachyarrhythmias. Crit Care Med. 2001; 29(6):1149-53. DOI: 10.1097/00003246-200106000-00011. View

15.

Abdelmoneim S, Rosenberg E, Meykler M, Patel B, Reddy B, Ho J . The Incidence and Natural Progression of New-Onset Postoperative Atrial Fibrillation. JACC Clin Electrophysiol. 2021; 7(9):1134-1144. DOI: 10.1016/j.jacep.2021.02.005. View

16.

Mattioli A, Bonatti S, Zennaro M, Melotti R, Mattioli G . Effect of coffee consumption, lifestyle and acute life stress in the development of acute lone atrial fibrillation. J Cardiovasc Med (Hagerstown). 2008; 9(8):794-8. DOI: 10.2459/JCM.0b013e3282f64554. View

17.

Zhu W, Fu L, Ding Y, Huang L, Xu Z, Hu J . Meta-analysis of ATRIA versus CHADS-VASc for predicting stroke and thromboembolism in patients with atrial fibrillation. Int J Cardiol. 2016; 227:436-442. DOI: 10.1016/j.ijcard.2016.11.015. View

18.

Forleo G, Mantica M, De Luca L, Leo R, Santini L, Panigada S . Catheter ablation of atrial fibrillation in patients with diabetes mellitus type 2: results from a randomized study comparing pulmonary vein isolation versus antiarrhythmic drug therapy. J Cardiovasc Electrophysiol. 2008; 20(1):22-8. DOI: 10.1111/j.1540-8167.2008.01275.x. View

19.

Hasbrouck M, Nguyen T . Acute management of atrial fibrillation in congestive heart failure with reduced ejection fraction in the emergency department. Am J Emerg Med. 2022; 58:39-42. DOI: 10.1016/j.ajem.2022.03.058. View

20.

Okin P, Wachtell K, Devereux R, Harris K, Jern S, Kjeldsen S . Regression of electrocardiographic left ventricular hypertrophy and decreased incidence of new-onset atrial fibrillation in patients with hypertension. JAMA. 2006; 296(10):1242-8. DOI: 10.1001/jama.296.10.1242. View