Atrial fibrillation is an inefficient cardiac rhythm associated with impaired exercise tolerance, exertional dyspnoea, palpitation and a substantial risk of thromboembolism. 2. The first decision in management is to consider cardioversion which can be achieved in suitable cases electrically, or pharmacologically with a class Ic antiarrhythmic drug like flecainide or propafenone. 3. Prophylaxis in paroxysmal atrial fibrillation is best achieved with a class Ic drug or a class III drug such as sotalol or amiodarone. 4. Control of ventricular rate in chronic atrial fibrillation can be achieved by pharmacological manipulation of the atrioventricular node by digoxin alone, or in combination with the calcium channel blockers verapamil or diltiazem, or beta-adrenoceptor blockers with intrinsic sympathomimetic activity like pindolol or xamoterol. 5. In view of the considerable risk of thromboembolism in patients with chronic atrial fibrillation anticoagulation or at least treatment with aspirin should be considered.
