Atrial fibrillation and thromboembolic stroke.

Long-term oral warfarin should be administered to patients with atrial fibrillation who have a history of systemic embolism, mitral valve disease, nonvalvular atrial fibrillation, or mitral annular calcium to reduce the incidence of thromboembolic stroke. Aspirin 325 mg/d may be given to patients with non-valvular atrial fibrillation who have contraindications to warfarin and to patients with nonvalvular atrial fibrillation younger than 75 years of age who have a low risk of systemic thromboembolism. Patients with lone atrial fibrillation younger than 60 years of age should not receive anticoagulants. However, low-dose oral warfarin should be given to elderly patients with lone atrial fibrillation. Digoxin, verapamil, diltiazem, and propranolol may be used to control ventricular rate in atrial fibrillation. I would not routinely use antiarrhythmic drugs but would use propranolol in patients with atrial fibrillation with ventricular arrhythmias or after conversion of atrial fibrillation to sinus rhythm.