Atrial fibrillation: a practical review and approach

ABSTRACT

Atrial fibrillation (AF) is a global health problem. The condition brings an increased risk of stroke, systemic embolism, and heart failure and is associated with impaired quality of life, frequent hospitalizations, and mortality. Prevention of AF-related complications relies on antithrombotic therapy, control of ventricular rate, and adequate therapy of concomitant cardiac diseases. Long-term antithrombotic therapy should be guided by the patient’s risk for thromboembolism, after an evaluation of the bleeding risk, and a discussion of the pros and cons and the patient preferences. Symptoms related to AF are an important determinant in making the decision to opt for rate- or rhythm-control in addition to factors that may influence the success of rhythm control. Therefore, setting a successful patient-tailored therapeutic strategy can be a challenging goal to achieve. This review provides a comprehensive overview of the management of atrial fibrillation in the light of the latest 2014 American Heart Association/American College of Cardiology/Heart Rhythm Society guidelines and the 2012 focused update of the European Society of Cardiology guidelines.