[Atrial fibrillation--from delirium cordis to therapeutic challenge].

Atrial fibrillation may develop in patients without (line atrial fibrillation) or with heart disease. Its prevalence raises with age. Medical or electrical cardioversion should be considered in view of the unfavourable hemodynamics and the increased risk of embolic events. Class-I antiarrhythmics given to sustain sinus rhythm after cardioversion are fraught with the risk of sudden death and should therefore be replaced by class-III antiarrhythmics. Control of heart rate in persisting atrial fibrillation is achieved best by digitalis glycosides at rest and by calcium channel blockers of the verapamil type or beta blockers during exercise. The risk of embolism in nonvalvular atrial fibrillation is reduced by mild oral anticoagulation and, probably to some extent, also by aspirin (300 mg daily). Ablation of the AV-node or an accessory pathway or heart surgery (maze procedure) may provide help in special cases.