Current management of atrial fibrillation

Abstract

Atrial fibrillation is a common condition and carries the risk of cerebral thromboembolism. The CHADS2 score is often used to stratify this risk. Anticoagulant therapy with warfarin significantly reduces this risk, but there are limitations to its use. This has prompted the use of antiplatelet drugs. Patients with mitral valve disease should always be considered for anticoagulant therapy. However for other patients with atrial fibrillation, the decision about which drug to use is based on the patient's risk of thromboembolism. In addition to stroke prevention, management is directed towards restoring and maintaining sinus rhythm or controlling the ventricular rate in those for whom permanent atrial fibrillation is accepted. For some patients percutaneous (catheterdirected) creation of lesions within the left atrium may be effective in maintaining sinus rhythm.