The new guidelines classify AF into five categories: first diagnosed AF, paroxysmal AF, persistent AF, long-standing persistent AF, and permanent AF. The new guidelines state that permanent atrial fibrillation will no longer be considered a rhythm control strategy. The new guidelines define long-standing persistent AF as AF that has lasted longer than 1 year and is intended to be treated with a rhythm control strategy, i.e., catheter ablation. The new guidelines state that for patients with suspected or confirmed AF, a detailed medical history is particularly important, including: whether the patient perceives his or her own heart rhythm to be regular during symptomatic episodes; whether there are precipitating factors for AF episodes, such as exercise, emotional stress or alcohol consumption; the severity of symptoms; whether episodes are frequent and the duration of each episode; whether other diseases are combined, such as hypertension, coronary artery disease, heart failure (heart failure), peripheral vascular disease, cerebrovascular disease, or other conditions, peripheral vascular disease, cerebrovascular disease, stroke, diabetes mellitus or chronic lung disease; whether alcoholism is present; and whether there is a family history of atrial fibrillation. The new guidelines for the first time propose a classification based on the European Heart Rhythm Association (EHRA) atrial fibrillation-related symptom score. activities. It should be noted that the symptoms associated with the EHRA score are only related to atrial fibrillation and will disappear or decrease when atrial fibrillation is converted to sinus rhythm or ventricular rate is controlled. The EHRA classification of AF-related symptoms is an important basis for the selection of treatment strategies, and the EHRA score is recommended to evaluate the severity of AF-related symptoms (I, B). Risk stratification In terms of risk stratification for stroke and thromboembolism, the new guideline proposes a new scoring system, the CHA2DS2VASc score (Table 1), which changes the age ≥75 years from 1 to 2 points based on the CHADS2 score, and adds three additional risk factors of vascular disease, age 65-74 years, and sex (female) risk factors. Based on the CHA2DS2VASc score, the new guidelines suggest options for selecting antithrombotic treatment strategies. The new guidelines recommend the selection of oral anticoagulants: antithrombotic therapy should be administered to prevent thromboembolic complications in all patients with atrial fibrillation, except in low-risk patients (isolated atrial fibrillation, age <65 years) or in the presence of contraindications (I, A). The CHADS2 score is simple and easy to remember and is recommended for initial stroke risk assessment in non-valvular AF (I, A). More detailed and comprehensive stroke risk assessment (e.g., CHADS2 score of 0 to 1) is recommended using a risk factor-based approach, taking into account the patient's "major" and "clinically relevant non-major stroke risk factors" (I, A). Patients without risk factors (age <65 years with isolated AF without any risk factors) may be excluded from any antithrombotic therapy, including aspirin (IIa, B). For patients who refuse oral anticoagulants or have contraindications to taking them, a combination of 75-100 mg aspirin and 75 mg clopidogrel may be substituted (IIa, B). The new guidelines state that patients with atrial fibrillation should be assessed for bleeding risk before starting anticoagulation therapy. The new guidelines recommend the introduction of the first HAS-BLED bleeding risk score (Table 2), which includes hypertension, hepatic and renal impairment, stroke, history of bleeding, INR fluctuations, old age (e.g., age >65 years), medications (e.g., combination of antiplatelet agents or NSAIDs), or alcohol use, to evaluate the risk of bleeding in patients with AF, with a score of ≥3 indicating “high risk. Patients at high risk for bleeding should be treated with caution and reviewed regularly after starting antithrombotic therapy, regardless of whether they are receiving warfarin or aspirin. For patients with non-valvular atrial fibrillation, the new guidelines still recommend controlling INR 2 to 3, weighing the risk of stroke at low INR against the risk of bleeding at high INR. The new guidelines also note that warfarin metabolism is affected by drugs, food, and alcohol; INR fluctuates widely from patient to patient and from patient to patient at different times while taking warfarin. In recently published controlled clinical trials, INR was controlled at 2 to 3 only 60% to 65% of the time, and in the real world, this number may be less than 50%, and in China it is even lower. If the INR reaches therapeutic range less than 60% of the time, it is possible that the benefit of taking warfarin is completely offset. It is important to note that this criterion may not be entirely appropriate for the Chinese population due to ethnic differences. The new guidelines emphasize the importance of planned clinical follow-up in addition to baseline assessment and initial treatment. (1) Whether stroke risk factors have changed (e.g., new diabetes, hypertension, etc.) and, in particular, whether anticoagulation is indicated. (2) Whether anticoagulation is currently indicated, whether there are emerging stroke risk factors, or whether anticoagulation is necessary e.g. low-risk patients with thromboembolism should be given low-molecular heparin anticoagulation after resuscitation. (3) Whether the patient’s symptoms improve after treatment, and if not, whether a change in treatment regimen is required. (4) Whether signs or risks of proarrhythmia appear and, if so, whether drug dose adjustment or change of treatment regimen is required. (5) Whether paroxysmal atrial fibrillation has progressed to persistent/permanent atrial fibrillation while on AAD and whether a change in treatment regimen is required. (6) What is the efficacy of ventricular rate control and whether the target heart rate at rest and during physical activity is achieved. Pharmacological treatment The primary goal of heart rate control is symptom relief with relaxation Previous guidelines recommended a strict heart rate control strategy of 60-80 beats/min at rest and 90-115 beats/min during moderate physical activity. Based on the recently published RACE II study, the new guidelines suggest that for patients without severe tachycardia-related symptoms, a relaxed heart rate control strategy is reasonable; for patients with a strict ventricular rate control strategy, an exercise test and 24-h ambulatory electrocardiogram are required for safety reasons if the heart rate is too fast during physical activity. The choice of drugs includes β-blockers, non-dihydropyridine calcium antagonists and digoxin; if these drugs are not effective, amiodarone can be used to control the ventricular rate of atrial fibrillation; in addition, dronedarone can effectively slow down the heart rate at rest or during activity, and can be used to control the heart rate of recurrent paroxysmal atrial fibrillation. Rhythm control strategies are usually employed primarily to alleviate symptoms associated with AF; conversely, antiarrhythmic drug (AAD) therapy is usually not required in patients without significant symptoms (or in patients who are asymptomatic after heart rate control therapy). The following should be noted when taking AADs to maintain sinus rhythm: (1) The aim of treatment is to reduce symptoms associated with atrial fibrillation; (2) The effect of AADs to maintain sinus rhythm is limited; (3) Anti-arrhythmic therapy is effective mainly in reducing atrial fibrillation episodes, not in eliminating atrial fibrillation; (4) When one AAD is ineffective, it can be replaced by another AAD; (5) Proarrhythmic effects and extracardiac adverse effects of the drug are common; (6) Compared with efficacy The safety of AAD application should be paid more attention than the efficacy. Commonly used AADs include amiodarone, dronedarone, flecainide, propafenone, and sotalol (all I, A). To date, amiodarone remains the most efficacious of all AADs for maintaining sinus rhythm (I, A), and in view of its toxic effects, it is usually considered only when other drugs are ineffective or contraindicated (I, C); amiodarone should be considered in patients with severe heart failure, NYHA class III/IV or recent cardiac instability (NYHA class II), who have experienced cardiac dysfunction within 1 month ( I, B). The new guidelines recommend catheter ablation for patients with atrial fibrillation who have significant symptoms despite reasonable drug therapy. For a specific patient, catheter ablation should also take into account: type of AF, left atrial size, history of AF; severity of co-morbid cardiovascular disease; alternative therapy (AAD, heart rate control); and patient preference. There is a lack of information on whether catheter ablation of asymptomatic AF is also beneficial. The status of catheter ablation in the treatment of atrial fibrillation has increased in the new guidelines compared with the previous guidelines. For typical atrial flutter documented before or during ablation, the new guidelines recommend atrial flutter ablation (I, B); for paroxysmal atrial fibrillation with significant symptoms that fails to respond to drug therapy, catheter ablation is recommended (IIa, A); for persistent atrial fibrillation with significant symptoms that fails to respond to drug therapy, catheter ablation may be considered (IIa, B); and for patients with atrial fibrillation in combination with heart failure whose symptoms are not controlled by drugs including amiodarone Catheter ablation (IIb, B) is considered in patients with AF with combined heart failure whose symptoms cannot be controlled with medications including amiodarone; Catheter ablation (IIb, C) is considered for the first time in paroxysmal AF without serious underlying heart disease if heart rate control is not effective prior to AAD therapy; Catheter ablation (IIb, C) is also considered in symptomatic long course persistent AF if AAD therapy is not effective. The new guidelines objectively point out that catheter ablation of atrial fibrillation is highly dependent on the experience of the operator, and the current studies related to catheter ablation of atrial fibrillation are invariably performed by experienced operators and advanced electrophysiology centers, so widespread dissemination needs to be cautious.