Management of atrial fibrillation

Abstract

Atrial fibrillation (AF) is a condition of genuine clinical concern. This arrhythmia increases patient morbidity and mortality, most notably due to stroke, thromboembolism and heart failure. Consequentially, there is a strong impetus to acquire a greater understanding of its natural history and course in order to provide crucial evidence-based treatment and resource allocation in the future. The objective of this review article is to present a concise overview of the management of AF, with reference to the recent evidence-based National Institute of Clinical Excellence (NICE) National Clinical Guidelines for the management of AF.

Figure 1

Practical guidelines for antithrombotic therapy in non-valvular atrial fibrillation. Assess risk, and reassess regularly. Note: Risk factors are not mutually exclusive, and are additive to each other in producing a composite risk. An echocardiogram not needed for routine risk assessment but refines clinical risk stratification in case of moderate or severe left ventricular dysfunction and valve disease. †Owing to lack of sufficient clear cut evidence, treatment may be decided on an individual basis, and the physician must balance the risks and benefits of warfarin versus aspirin; as stroke risk factors are cumulative, warfarin may (for example) be used in the presence of 2 or more risk factors. Referral and echocardiography may help in cases of uncertainty. *Since the incidence of stroke and thromboembolic events in patients with thyrotoxicosis appears similar to other aetiologies of AF, antithrombotic therapies should be chosen based on the presence of validated stroke risk factors. Abbreviations: INR, international normalized ratio; CVA, cerebrovascular accident;TIA, transient ischemic attack.