Whatever the cause and clinical features, establishing the strategy fo
r the medical treatment of atrial fibrillation, requires three basic s
teps. First sinus rhythm must be restored, followed by the prescriptio
n of antiarrhythmic drugs to prevent recurrence and finally the use of
anticoagulants. Obviously the underlying heart disease has a major ef
fect on the patient's tolerance of atrial fibrillation, the risks of p
eripheral embolism and overall mortality. In patients with ''solitary
atrial fibrillation'' and an apparently normal heart, each step of the
treatment must be examined in light of the individual patients clinic
al situation and the risks of haemorrhage with anticoagulants as well
as the risk of lethal ventricular arrhythmia due to the arrhythmogenic
effect of class Ia or 1c antiarrhythmic drugs.