Feature Article

Current management of atrial fibrillation

David Gallagher
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Rate control plus anticoagulation is the usual therapy for atrial fibrillation. A rhythm control strategy has not been shown to have prognostic benefits over rate control with anticoagulation but is useful for symptom management.

Key Points

  • Most patients with atrial fibrillation are elderly or have hypertension and are at high risk of cardiac embolism.
  • The goals of management include control of symptoms, preservation of left ventricular function and prevention of cardiac embolism.
  • Rate control and anticoagulant therapy can be initiated in stable patients by the GP while awaiting specialist review.
  • Anticoagulation is underutilised in high risk groups.
  • A patient’s therapy should be re-evaluated over time because both the risk of embolism and the incidence of conduction disease increase with age.