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Management of atrial fibrillation
  1. Gregory Y H Lip,
  2. Antonio Tello-Montoliu
  1. Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK
  1. Correspondence to:
    Professor Gregory Y H Lip
    Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham B18 7QH, UK; g.y.h.lip{at}bham.ac.uk

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Atrial fibrillation (AF) is a supraventricular tachyarrhythmia characterised by uncoordinated atria activation with consequent deterioration of atrial mechanical function. It is the most common arrhythmia encountered in the clinical practice of the developed countries,1w1 and accounts for 1% of all National Health Service expenditure in the United Kingdom.w2

The prevalence and incidence of AF increases with advancing age, affecting approximately 5% of individuals older than 65 years and nearly 10% of those aged older than 80 years.2 So common is this problem that it is expected that more than five million Americans will be living with AF by the year 2050.w1 AF also coexists with common cardiovascular conditions, such as hypertension, heart failure, coronary artery disease and diabetes mellitus, and with an increasingly older general population, AF (and its co-morbidities) will become an increasing health care burden.2w3 w4 Indeed, hospitalisation rates for AF have increased by 2–3 fold.w4 In the Framingham Heart Study, AF was associated with a 1.5- to 1.9-fold mortality risk, even after adjustment for the pre-existing cardiovascular conditions.w5 AF also confers a substantial morbidity from stroke, thromboembolism, heart failure and impaired quality of life; indeed, stroke survivors associated with AF have more severe strokes with greater disability, longer hospital stays and lower rates of discharge to their own home.2

The aim of this review is to provide a practical and clinically useful approach to the management of AF. The current 2001 American College of Cardiology/American Heart Association/European Society of Cardiology (ACC/AHA/ESC) consensus guidelines1 for the management of patients with AF will be updated in late 2006, and the evidence-based UK National Institute for Health and Clinical Excellence (NICE) guidelines are available (www.nice.org.uk) in their final form from June 2006. The extensive literature on the electrophysiology and …

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