Atrial fibrillation: an update on new management strategies

Atrial fibrillation is a common arrhythmia that frequently results in significant and sometimes refractory clinical symptoms of palpitations, effort intolerance, and breathlessness. The clinical picture, as well as a real risk of embolism, make appropriate management an important priority in medical practice. Older strategies, such as reliance on pharmacologic therapy to control ventricular rate, are being displaced by newer techniques to maintain sinus rhythm. These techniques often involve a combination of electrical cardioversion, use of newer direct-acting AV nodal blocking drugs and antiarrhythmic medication, AV node ablation and modification procedures, and permanent pacemaker therapy. These newer treatment approaches--together with anticoagulation and antiplatelet therapy--continue to evolve, with the goal of optimizing the lifespan and lifestyle of patients with this rhythm disorder.