Treatment of atrial fibrillation

Individualising atrial fibrillation (AF) treatment helps you optimise symptomatic outcomes and reduce stroke risk.

This part of the Learning Zone introduces the various AF treatments. Up to 50% of patients with recent onset AF spontaneously convert to sinus rhythm.20 The remainder need one or more of the treatments covered in this section. The ESC/EHRA guidelines stress the importance of counselling patients starting AF management to prevent unrealistic expectations and to optimise QoL.5

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Broadly, patients and clinicians need to decide between rhythm and rate control. Currently, no trial data compares rhythm and rate control as an initial AF treatment. However, consensus guidelines suggest restoring sinus rhythm, which may control AF arising from potentially reversible causes or in those patients experiencing an isolated episode.6

If AF recurs, patients who seem especially suitable for rhythm control include:6

  • those who showed a symptomatic improvement during normal sinus rhythm
  • young people
  • those with AF without underlying heart disease
  • patients with substantial symptoms despite control of ventricular rate

Anticoagulation is an important aspect of management to reduce the risk of ischaemic stroke in all AF patients.5,37 

Detailed information within the treatment section of stroke and atrial fibrillation is available below:

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