. 2022 Feb 4;17(14):e1126–e1196. doi: 10.4244/EIJ-E-21-00009

Recommendations B. Recommendations on management of atrial fibrillation in patients with native VHD.

Recommendations	Class^a	Level^b
Anticoagulation
For stroke prevention in AF patients who are eligible for OAC, NOACs are recommended in preference to VKAs in patients with aortic stenosis, aortic and mitral regurgitation. 75,76,77,78,83,84	I	A
The use of NOACs is not recommended in patients with AF and moderate to severe mitral stenosis.	III	C
Surgical interventions
Concomitant AF ablation should be considered in patients undergoing valve surgery, balancing the benefits of freedom from atrial arrhythmias and the risk factors for recurrence (LA dilatation, years in AF, age, renal dysfunction, and other cardiovascular risk factors). 79,85,86,87,88,89,90	IIa	A
LAA occlusion should be considered to reduce the thromboembolic risk in patients, with AF and a CHA₂DS₂VASc score ≥2 undergoing valve surgery. 82	IIa	B
AF: atrial fibrillation; LA: left atrium/left atrial; LAA: left atrial appendage; NOAC: non-vitamin K antagonist oral anticoagulant; OAC: oral anticoagulation; VKA: vitamin K antagonist. ^aClass of recommendation. ^bLevel of evidence.