Atrial fibrillation

Atrial fibrillation (AF) is the commonest sustained arrhythmia in clinical practice with higher prevalence in the elderly. It is associated with significant increased mortality and morbidity related to its complications such as stroke, thromboembolism and heart failure. In population-based studies, hypertension is the commonest co-morbid condition associated with AF. The approach to management of AF is largely symptom driven, and can be broadly described as ‘rhythm control’ for recurrent (that is, paroxysmal and persistent) AF and ‘rate control’ for permanent AF. The stroke risk with AF appears non-homogenous and is often related to co-existent conditions, such as hypertension, diabetes, valvular heart disease, left ventricular dysfunction and previous strokes. All patients with AF should be risk stratified to minimize thromboembolic complications. With the available data, the vitamin K antagonists should be the first-line antithrombotic therapy in AF patients who are in moderate and high stroke risk categories. Newer generation antiarrhythmic and antithrombotic drugs may offer better treatment options towards improving clinical outcomes in these patients.