Atrial fibrillation: a new perspective on an old problem

Irene Stevenson



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.

Key Points

  • 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.

    Picture credit: © Milatas/ Model used for illustrative purposes only.