Figure 1.

Overall AF treatment strategy schema. This is a simplified schema of the main steps in AF management. Haemodynamic stability must first be ensured, and any precipitators or comorbidities addressed. Anticoagulation is an essential early step in almost all patients to prevent thromboembolic complications. Rate control must be established, even in most patients for whom the primary approach will be rhythm control, since pharmacological rhythm control is not foolproof and rhythm-control drugs can cause a paradoxical acceleration in ventricular rate. The choice between rate control and rhythm control as the principal strategy is based on a variety of patient-specific considerations.