Managing atrial fibrillation has until recently centred on decisions about anticoagulation and controlling cardiac rate and cardiac rhythm. New evidence strongly supports inclusion of a fourth cornerstone – risk factor modification.
- The three cornerstones of atrial fibrillation (AF) management have traditionally been anticoagulation, rate control and rhythm control.
- There is increasing evidence that modification of three main risk factors obstructive sleep apnoea, obesity and exercise improves outcomes.
- Treatment of patients with sleep apnoea using continuous positive airway pressure reduces the risk and recurrence of AF.
- Patients undergoing cardioversion or AF ablation should be actively screened for sleep apnoea and treated if it is present.
- Weight loss has a dose-related impact on AF, with a gradual and sustained weight loss of 10% or more without fluctuations having the greatest benefit.
- Light to moderate exercise is protective against AF.
- Risk factor management is essential in conjunction with antiarrhythmic medications and AF ablation to maximise treatment effects.
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