R E V I E W Management of atrial ﬁbrillation Puneet Kakar1 Christopher J Boos1, 2 Gregor y YH Lip1 1Hemostasis, Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK 2Army Medical Directorate, FASC, Camberley, Surrey, UK Correspondence: Gregory YH Lip Hemostasis,Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham B18 7QH, UK Tel +44 121 507 5080 Fax +44 121 554 4083 Email g.y.h.lip@bham.ac.uk Abstract: Atrial ﬁbrillation (AF) is a condition of genuine clinical concern. This arrhythmia increases patient morbidity and mortality, most notably due to stroke, thromboembolism and heart failure. Consequentially, there is a strong impetus to acquire a greater understanding of its natural history and course in order to provide crucial evidence-based treatment and resource allocation in the future. The objective of this review article is to present a concise overview of the management of AF, with reference to the recent evidence-based National Institute of Clinical Excellence (NICE) National Clinical Guidelines for the management of AF. Keywords: atrial ﬁbrillation, National Institute of Clinical Excellence, guidelines Introduction Atrial ﬁbrillation (AF) is the most frequently encountered and sustained cardiac ar- rhythmia in clinical practice, with an overall population prevalence of 0.65% in the United Kingdom (Stewart et al 2001). The incidence of AF has a male predisposition, affecting men 1.5 times more commonly than women (Benjamin 1994). The prevalence of AF is highly age dependent; occurring in less than 1% of the population aged under 50 and about 10% of those above 80 (Freestone et al 2003). Furthermore, it is pres- ent in 3%–6% of acute medical admissions (Lip et al 1994). Given an aging general population, the predominance of AF among the elderly and the improved survival of patients with cardiovascular disease, its frequency is dramatically increasing. AF exacts a signiﬁcant clinical burden. For example, AF is an independent predictor of mortality and is associated with an odds ratio for death of 1.5 for men and 1.9 in women, independent of other risk factors (Benjamin et al 1998). AF increases the risk of stroke by 4–5 fold and accounts for 10%–15% of all ischemic strokes and nearly a quarter of strokes in patients aged 80 and over (Lip et al 2001, 2005a). Furthermore, it is linked to far more severe strokes, with longer hospitalization and higher 30-day mortality compared with subjects without AF (Wolf et al 1991; Lin et al 1996). In addition, AF increases the development of heart failure and adversely affects quality of life, including cognitive function (Freestone et al 2003). AF is most commonly classiﬁed according to its temporal pattern (Levy et al 2003). Paroxysmal AF is deﬁned as a self-terminating AF episode lasting less than 7 days, and usually less than 48 hours. Sustained AF, lasting longer than 7 days and less than a year, is classiﬁed as persistent. Where AF persists beyond a year, it is classiﬁed as permanent, irrespective of the fact that there may have been temporary resolution after cardioversion. Paroxysmal AF may degenerate into more frequent paroxysms, or a sustained form of AF, which in turn may degenerate into permanent AF. ‘Lone AF’ is largely a diagnosis of exclusion and refers to AF occurring in the absence of con- comitant cardiovascular disease (eg, hypertension), structural heart disease (normal echocardiogram), with a normal ECG and chest X-ray. Vascular Health and Risk Management 2007:3(1) 109–116 © 2007 Dove Medical Press Limited. All rights reserved 109