Atrial fibrillation: the most common arrhythmia

Atrial fibrillation is the most common sustained arrhythmia, increases with age, and presents with a wide spectrum of symptoms and severity Paroxysmal, persistent, and permanent forms require very individualized approaches to management. New information about electrical and anatomic remodeling emphasizes the importance of time-related thrombogenicity and progressive interference with mechanical function of the atria and ventricles. The most important aspect of diagnosis is risk stratification with respect to risk of thromboembolism. The general goals in treatment are, in order of importance: prevention of thromboemboli, control of ventricular response, restoration of sinus rhythm, and maintenance of sinus rhythm by preventing recurrences. This review focuses on the above issues. The therapeutic choices are discussed under each category Antiarrhythmic drugs, radiofrequency ablation techniques, and device therapy are reviewed with respect to prevention of recurrent atrial fibrillation.