A new evidence-based guideline was released by the National Institute for Health and Clinical Excellence (NICE) in June 2006 for the management of patients with atrial fibrillation. Although there have been several (mostly expert consensus) guidelines and systematic reviews of atrial fibrillation published over the past few years with varying degrees of focus,^1–,⁴ this is the first time that a full national guideline has been produced for the management of this important condition, using the rigorous guideline development methods used by NICE for all of its clinical guidelines.^5,6 Full details of this process can be found on the NICE website (www.nice.org.uk), but it is relevant to highlight some key components of this method in order to appreciate fully the strengths and the limitations of the guideline.

A WELL DEFINED SCOPE

Firstly, and perhaps most importantly, it must be accepted that the guideline is not intended to be a fully comprehensive manual dealing with every possible aspect of the investigation and management of atrial fibrillation, but that it has been developed in response to a well-defined scope. The full scope is shown as an appendix to the guideline, and this specifies those aspects of atrial fibrillation which were to be included, and those which were excluded. The scope, as with …