Atrial Fibrillation: Clinical Features, Mechanisms, and Management

Atrial fibrillation is the most common cardiac arrhythmia. It is important because it increases the risk of stroke, impairs quality of life, increases the risk of heart failure, and shortens survival. Atrial fibrillation has also been associated with an increased risk of dementia. Once diagnosed there are four cornerstones to management. The first is the use of anticoagulants to reduce stroke risk in AF patients with a high stroke risk profile. The second is rate control to reduce the rest heart rate to less than 80 bpm. The third component of management is rhythm control, especially in patients who continue to have symptoms despite adequate rate control. Rhythm control can be achieved with antiarrhythmic medications, catheter ablation, or surgical AF ablation. The fourth component of AF management is risk factor modifications. It is now well recognized that weight reduction, treatment of sleep apnea, and limiting alcohol intake have a significant impact on the ability to restore and maintain sinus rhythm. This chapter provides a high level overview of AF management and a summary of current AF management guidelines.