Atrial fibrillation (AF) is the most frequent supraventricular arrhythmia with an approximative prevalence of 1 % in the general population and above 6 % in the elderly. Although the morbidity associated with AF, primarily heart failure and stroke, is well established, it is not clear if all AF result in excess mortality. Management of a first AF episode is different depending on the clinical status of patients. Practical guidelines developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society are available for the management of these patients. A four-step decisional scheme must be followed in the management of a first recent AF episode: need for a short- and long-term anticoagulation, define a rythmologic strategy (rhythm or rate control), select the weapon (drug, device or ablation) and reconsider the strategy if needed. After a first uncomplicated paroxysmal AF episode, guidelines recommend that prescription of antiarrhythmics must be avoided and anticoagulation is optional. After a first persistent AF episode, guidelines recommend to either respect or reduce the arrhythmia. Prescription of antiarrhythmics and anticoagulation is also optional depending on the patients condition. In case of the AF reduction decision, anticoagulation must be tailored preliminary to this reduction. AF recurrence rate varies depending on the patients condition, and the risk of stroke assessed by the CHA2DS2-VASc score might be similarly considered for both paroxysmal and persistent AF.
Credits: Sophie Gomes MD; Laure Champ-Rigot MD; Anthony Foucault MD; Arnaud Pellissier MD; Alain Lebon MD; Patrice Scanu MD; Paul Milliez MD, PhD