Treatments for atrial fibrillation

Rate controlAsymptomatic atrial fibrillation and rhythm control not favored (elderly patient, long-standing atrial fibrillation, markedly enlarged left atrium)Avoid calcium channel blockers in patients with heart failure
Electric cardioversionSymptomatic atrial fibrillation
New-onset atrial fibrillation
Low risk of thromboembolism: (< 48 hours since onset of atrial fibrillation, or at least 3 weeks of anticoagulation, or transesophageal echocardiography to rule out thrombus)
No anticoagulation or inability to obtain transesophageal echocardiography
Antiarrhythmic medicationsYounger patient
High cardiovascular risk
Heart failure
Failure of rate control therapy
Avoid propafenone and flecainide in those with structural heart disease and coronary heart disease
Avoid dronedarone in persistent atrial fibrillation and congestive heart failure
Avoid sotalol and dofetilide in renal failure
Catheter ablationYounger patients
Symptomatic atrial fibrillation, refractory to medical therapy
Can be considered in heart failure
Marked left atrial dilation
Atrioventricular junction ablation and cardiac resynchronization therapyContraindication to ablation or failure of ablation
Permanent atrial fibrillation
Systolic heart failure with ejection fraction < 30%
Frail patient
Expected survival < 1 year