Recommendations and Guidelines for Diagnosing and Managing Atrial Fibrillation

This is a superb review article on atrial fibrillation (AF) that all clinicians caring for such patients should read, absorb, and implement. The authors summarize important clinical points including increased risk of death, stroke, heart failure and dementia associated with AF. Since hypertension, smoking, coronary disease, elevated lipids, diabetes, sleep apnea, obesity and excessive alcohol consumption may contribute to the risks of developing AF, treating and reducing these conditions may help lower that incidence. Caring for AF patients must embrace three major clinical concepts critical to patient wellbeing, including 1) rate and rhythm control, 2) stroke prevention and 3) attention to and reduction of contributing factors mentioned earlier. Clinicians need to be hyper alert for the presence of AF since as the population ages, the incidence of AF increases, developing in 1/3 after the age of 55 years, 1/3 of whom may be asymptomatic. In most patients, sinus rhythm is preferable to AF with rate control and can be achieved by appropriate pharmacologic or catheter ablation techniques. Multiple studies have shown the superiority of ablation over drugs but that decision rests on a critical discussion between patient and physician. The take home message for clinicians is to read this article and absorb its contents.