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Last Updated: 4/8/2014  

Atrial Fibrillation

  • Use an ACE inhibitor or ARB for primary prevention of AF in patients with hypertension-related LVH, a reduced ejection fraction, or HF.

  • Use statins to prevent AF in patients with ischemic heart disease.

  • Diagnose AF with resting ECG demonstrating absent P waves and an irregular ventricular response.

  • Obtain continuous ambulatory cardiac monitoring or cardiac event monitoring for patients with intermittent symptoms.

  • Selectively obtain additional laboratory data to determine AF etiology; for most patients this includes hemoglobin, serum electrolytes, TSH, pulse oximetry, and echocardiography.

  • Use β-blockers or calcium-channel blockers as first-line agents to control heart rate.

  • Use a risk stratification tool, such as CHADS2 or CHA2DS2-VASc to determine the long-term thromboembolic risk.

  • Treat patients at lowest risk for thromboembolism with antiplatelet therapy or no therapy.

  • Treat patients at increased risk for thromboembolism with warfarin, a direct thrombin inhibitor, or a factor Xa inhibitor.

  • Consider elective cardioversion for patients whose symptoms are not controlled with a rate-control strategy.

  • Note that catheter-based ablation of the AV node with placement of a ventricular pacer is an option for patients poorly controlled with or intolerant of drug therapy.

  • Perform emergent electrical cardioversion in patients with AF who are hemodynamically unstable.

DOI: 10.7326/d027
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Author(s) and Disclosures:
Victor A. Ferrari, MD has nothing to disclose. David Callans, MD, FACC has nothing to disclose. Susan Wiegers, MD has nothing to disclose. Jonathan L. Halperin, MD, FACP, FACC, FACP, FAHA, MSVM has received consulting fees from AstraZeneca, Bayer AG HealthCare, Biotronik, Boehringer Ingelheim, Boston Scientific, Daiicho Sankyo, Janssen, Johnson & Johnson, Medtronic, Ortho-McNeil-Janssen Pharmaceuticals, Pfizer, Sanofi-Aventis. Noah Moss, MD has nothing to disclose.

One or more of the present or past ACP Smart Medicine physician editors worked on this module and had nothing to disclose: Davoren Chick, MD, FACP; Deborah Korenstein, MD, FACP; Marjorie Lazoff, MD, FACP; Richard Lynn, MD, FACP.

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