Atrial fibrillation

With appropriate management and education most patients with atrial fibrill ation (AF) can lead normal lives. The risk of stroke and other thromboembolism is now widely appreciated and can be markedly reduced by anticoagulation therapy with warfarin. Tachycardia-induced cardiomyopathy is under-recognised; it too is preventab le or reversible by,,controlling rate and/or rhythm. The benefits of restoring sinus rhythm must be balanced in each patient aga inst the risk of adverse effects antiarrhythmic medication or procedures. Decreasing frequency and duration of AF episodes using antiarrhythmic medic ations has not to date been shown to decrease mortality or stroke rate. Anticoagulation and rate control are important considerations in paroxysmal AF as well as in permanent AF. Contraindications to warfarin include poorly controlled hypertension, but n ot peptic ulcer disease or advanced age per se.