Atrial Fibrillation: National Clinical Guideline for Management in Primary and Secondary Care

Excerpt

The guideline covers aspects of diagnosis and the management of atrial fibrillation (AF) in a number of different circumstances. It covers paroxysmal, persistent and permanent AF, considers AF developing after surgical procedures, and offers advice on haemodynamically unstable AF. Many of the recommendations relate to control of AF and the important decision of whether to attempt to restore sinus rhythm or concentrate on control of the heart rate. In a linked set of recommendations, the importance of considering anticoagulation in all these patients is emphasised. This is sometimes neglected in clinical practice, but anticoagulation is of enormous potential benefit because of its role in stroke prevention, and one of the key recommendations in the guideline is that the risk of thromboembolism should be formally assessed. A simple clinical model that includes advice on appropriate prophylaxis is suggested for this purpose. Other key recommendations cover the use of the electrocardiogram in diagnosis, and the preference in most patients for beta-blockers or rate-limiting calcium antagonists over digoxin for rate control.