Medical Management of Atrial Fibrillation

Atrial fibrillation (AF) is a supraventricular tachyarrhythmia where uncoordinated atrial electrical activity results in ineffectual atrial mechanical action and irregular ventricular response. AF is the commonest sustained arrhythmia and its prevalence increases with age. AF is often associated with underlying structural or functional heart disease, but there may not be any detectable heart disease in a significant minority of patients. Apart from symptoms of AF per se, AF is notorious to engender haemodynamic and thromboembolic complications. In the following brief overview, I shall highlight the contemporary issues in the medical management of AF , eg, pharmacological cardioversion, strategies for maintaining sinus rhythm, the burning issue of rate versus rhythm control, strategies for rate control, risk assessment for thromboembolic complications and the prophylaxis of thromboembolism.