SKC Algorithm – Comprehensive Management of Atrial Fibrillation

Comprehensive management of atrial fibrillation (AF) is based on three pillars:

Prevention of stroke and thromboembolism using anticoagulation therapy
Adequate treatment of comorbidities and elimination of risk factors
Elimination of AF (maintenance of sinus rhythm) or alleviation of AF symptoms

Compendium of recommendations for AF (2026) uses the SKC algorithm for the treatment of AF; the abbreviation SKC stands for:

SK – Slovakia
C – CINRE, the cardiology centre where the author of the guidelines works: Peter Blahut

Infographic illustrating the SKC treatment algorithm for atrial fibrillation focused on stroke prevention, maintenance of sinus rhythm, and management of comorbidities and risk factors.

SKC Algorithm (Comprehensive Management of Atrial Fibrillation)
S	Stroke The goal is to prevent stroke and thromboembolism using anticoagulation therapy. Anticoagulation therapy is indicated according to the CHA₂DS₂-VA score.
K	Keep the Sinus Rhythm The goal is to maintain sinus rhythm using: antiarrhythmic therapy pulsed field ablation During sinus rhythm, symptoms are reduced and often disappear. If sinus rhythm cannot be maintained, the strategy is rate control.
C	Comorbidities and Risk Factors The goal is adequate treatment of comorbidities and elimination of risk factors.

Comprehensive AF management according to the SKC algorithm:

Is the same for all patients with AF, regardless of AF classification by episode type (paroxysmal, persistent, permanent).
If substantial modification of comorbidities and risk factors is achieved,

regression of AF may occur: persistent → paroxysmal AF.
Complete disappearance of AF is rare (<10%).

Maintenance of sinus rhythm is primarily supported by antiarrhythmic therapy and ablation.

Several algorithms for AF management exist, all based on common principles: stroke prevention, rhythm or rate control, and treatment of comorbidities and risk factors. In clinical practice, the following algorithms are used:

SKC algorithm

S (Stroke)
K (Keep the Sinus Rhythm)
C (Comorbidities and Risk Factors)

ABC algorithm (European Guidelines 2020, Asian Guidelines 2021):

A (Avoid Stroke)
B (Better Symptom Management)
C (Cardiovascular and Other Comorbidities / Risk Factors)

SOS algorithm (American Guidelines 2023)

S (Stroke risk assessment and treatment)
O (Optimize all modifiable risk factors)
S (Symptom management)

AF-CARE algorithm (European Guidelines 2024)

AF (Atrial Fibrillation)
C (Comorbidities and risk factors)
A (Avoid Stroke)
R (Reduce symptoms by rate and rhythm control)
E (Evaluate and reassess)

SKC Algorithm – Comprehensive Management of Atrial Fibrillation	Class
Comprehensive AF management is recommended according to the SKC algorithm.	I
Comprehensive AF management is identical regardless of AF classification by episode type (paroxysmal, persistent, permanent).	I