Atrial Fibrillation

Atrial fibrillation (AF) is chaotic atrial electrical activity that eliminates coordinated atrial contraction. The atria no longer empty efficiently, the ventricles are activated irregularly, and the rapid or inconsistent ventricular rate can reduce cardiac output. Blood stasis, particularly in the left atrial appendage, creates thromboembolic risk even when the patient feels well or has temporarily returned to sinus rhythm. The rate-versus-rhythm question is only one part of the decision. Rate control slows transmission through the atrioventricular node; rhythm control attempts to restore and maintain sinus rhythm with cardioversion, antiarrhythmic medication, or ablation. Anticoagulation is decided separately. A patient may need anticoagulation after successful cardioversion, ablation, or AV-node ablation because the underlying stroke risk does not disappear with a normal monitor reading. The first clinical sorting step is safety: instability and pre-excited AF take priority over routine rate control. In a stable patient, ventricular function, symptoms, AF stage, duration, comorbidities, medication risk, and treatment goals determine the next step.