[Atrial fibrillation]

Atrial fibrillation is a common arrhythmia which consequences include disabling symptoms, haemodynamic impairment and frightening embolic complications. In 3/4 cases, they are represented by cerebrovascular accidents responsible of death or disabling sequella. Underlying heart disease is present in 70% of AF patients. Endpoints of therapy include: 1. prevention of embolic complications using oral anticoagulation in patients at risk; 2. control of symptoms and prevention of haemodynamic impairment either by restoring and maintaining sinus rhythm or by controlling ventricular heart rate. The same principles should be applied for emergency treatment: aside from AF with haemodynamic compromise (hypotension or syncope) which requires urgent electrical cardioversion, AF termination may be obtained with intravenous or oral antiarrhythmic therapy or the treatment confined to slowing of heart rate. Selecting the appropriate antiarrhythmic therapy for prevention of recurrences is based on the type of AF, paroxysmal or persistent, symptoms, underlying heart disease and left ventricular function. For patients refractory to drug therapy, non pharmacologic treatment represents an option including pacemaker, double chamber defibrillator, and radiofrequency ablation of ectopic foci most often located in the pulmonary veins or pulmonary vein isolation or surgery particularly if there is an indication for open-chest surgery. Non-pharmacological therapies should be restricted to very symptomatic patients who failed pharmacological therapy.