Atrial Fibrillation

Author: Clifford J Mann / Editor: Jason M Kendall / Reviewer: Martin Dore / Codes:A1 / Published: 15/01/2019

This session is about atrial fibrillation, the most common form of cardiac dysrhythmia.

After completing this session you will be able to:

  • Explain the importance of the duration of atrial fibrillation and its implications for treatment options
  • Identify which patients need emergency treatment of atrial fibrillation
  • Identify which patients are best suited to a rate control strategy
  • Identify which patients are best suited to a rhythm control strategy
  • Describe appropriate treatment options for patients presenting to the emergency department with atrial fibrillation
  • Describe how to assess stroke risk in all patients who present with atrial fibrillation


  1. NICE: Atrial Fibrillation: The management of atrial fibrillation.
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  3. Kirchhof P, Benussi S, Kotecha K et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J; 37: 38, 7
  4. Kishore A Vail A Majid A Dawson J Lees KR Tyrrell PJ Smith CJ . Detection of atrial fibrillation after ischemic stroke or transient ischemic attack: a systematic review and meta-analysis. Stroke 2014; 45: 520 526
  5. Lowenstein SR, Gabow PA, Cramer J, et al. The role of alcohol in new onset atrial fibrillation. Arch Intern Med 1983;143(10):1882-1885.
  6. Scheuermeyer FX. Emergency Department Patients With Atrial Fibrillation or Flutter and an Acute Underlying Medical Illness May Not Benefit From Attempts to Control Rate or Rhythm. Ann Emerg Med 2015; 65(5):511-522
  7. Recusitation council UK. Advances life support – Peri-arrest arrhythmias.
  8. Caldeira D, David C, Sampaio C et al. Rate versus rhythm control in atrial fibrillation and clinical outcomes: updated systematic review and meta-analysis of randomized controlled trials. Arch Cardiovasc Dis. 2012; 105(4):226-38
  9. Nuotio I, Hartikainen J, Grnberg T et al. Time to Cardioversion for Acute Atrial Fibrillation and Thromboembolic Complications. 2014;312(6):647-649
  10. Van Gelder IC, Groenveld HF, Crijns HJ, Tuininga YS, Tijssen JG, Alings AM, Hillege HL, Bergsma-Kadijk JA, Cornel JH, Kamp O, Tukkie R, Bosker HA, Van Veldhuisen DJ, Van den Berg MP, RACE II Investigators . Lenient versus strict rate control in patients with atrial fibrillation . N Engl J Med.2010; 362: 1363 1373
  11. Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2010 Feb;137(2):263-72.
  12. Hagens VE, et al., Effect of rate and rhythm control on left ventricular function and cardiac dimensions in patients with persistent atrial fibrillation: results from the RAte Control versus Electrical Cardioversion for Persistent Atrial Fibrillation (RACE) study.Heart Rhythm. 2005; 2:1924.
  13. Carlson J, Miketic S, Windeler J et al. randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation: the Strategies of Treatment of Atrial Fibrillation (STAF) Study. J Am Coll Cardiol. 2003;41(10):1690-1696)

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