NICE clinical guidelines
Issued: June 2006
CG36

Atrial fibrillation: The management of atrial fibrillation

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This is an extract from the guidance. The complete guidance is available at guidance.nice.org.uk/cg36

Key priorities for implementation

The following recommendations have been identified as priorities for implementation.

Identification and diagnosis

  • An electrocardiogram (ECG) should be performed in all patients, whether symptomatic or not, in whom atrial fibrillation (AF) is suspected because an irregular pulse has been detected.

Treatment for persistent AF

  • As some patients with persistent AF will satisfy criteria for either an initial rate-control or rhythm-control strategy (for example, age over 65 but also symptomatic):

    • the indications for each option should not be regarded as mutually exclusive and the potential advantages and disadvantages of each strategy should be explained to patients before agreeing which to adopt

    • any comorbidities that might indicate one approach rather than the other should be taken into account

    • irrespective of whether a rate-control or rhythm-control strategy is adopted in patients with persistent AF, appropriate antithrombotic therapy should be used.

Treatment for permanent AF

  • In patients with permanent AF, who need treatment for rate-control:

    • beta-blockers or rate-limiting calcium antagonists should be the preferred initial monotherapy in all patients

    • digoxin should only be considered as monotherapy in predominantly sedentary patients.

Antithrombotic therapy

  • In patients with newly diagnosed AF for whom antithrombotic therapy is indicated (see section 1.8.6), such treatment should be initiated with minimal delay after the appropriate management of comorbidities.

  • The stroke risk stratification algorithm (see full guideline) should be used in patients with AF to assess their risk of stroke and thromboembolism, and appropriate thromboprophylaxis given.