Established atrial fibrillation

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Primary prevention strategies are based on reducing risk factors through lifestyle modification.[1][2][3][51] US guidelines now recommend that patients at increased risk of atrial fibrillation (AF) receive comprehensive guideline-directed lifestyle and risk factor modification, which includes maintenance of ideal weight and weight loss if overweight or obese, having a physically active lifestyle, reducing unhealthy alcohol consumption, stopping smoking, controlling diabetes, and controlling blood pressure/hypertension.[1]

Use of ACE inhibitors, statins, and specific dietary lipid components present in certain types of fish have been shown to reduce the incidence of AF.[70][71][72][73][74][75] Preoperative treatment with a beta-blocker or amiodarone reduces post-operative incidence of AF in patients undergoing cardiac surgery or in patients at high risk for AF.[1][5] [ ] [ ] Non-pharmacological interventions, including atrial pacing, may also be considered for prevention of post-operative AF in patients undergoing cardiac surgery.[76] [ ]

In patients with obstructive sleep apnoea, optimal management of the condition may reduce AF incidence and recurrences.[1][2]

Moderate physical activity may prevent the development of AF; however, it has been found that strenuous activity can increase the risk of AF.[3][77] It may be appropriate to recommend caution to those who pursue years of regular, high-volume (≥3 hours/day) high-intensity endurance training; observational data exists linking this with increased AF risk in men and similar J-curve risk observed for high or vigorous activity in both men and women in another study.[1][78][79]

Secondary prevention

US guidelines now recommend that all patients with AF receive comprehensive guideline-directed lifestyle and risk factor modification, which includes secondary prevention measures: maintenance of ideal weight and weight loss if overweight or obese, having a physically active lifestyle, reducing unhealthy alcohol consumption, stopping smoking, controlling diabetes, and controlling blood pressure/hypertension.[1]

Weight reduction with intensive risk factor management has been shown to reduce AF symptom burden and severity, and result in beneficial cardiac remodelling.[3][211][212][213] Supervised exercise training has been shown to help reduce AF recurrence, improve quality of life, and improve cardiorespiratory fitness and functional capacity.[214][215][216]

Optimal management of obstructive sleep apnoea may reduce AF incidence, recurrence, progression, and symptoms.[2][45][217]

Reducing or stopping alcohol intake may reduce arrhythmia recurrences.[3]

Cigarette smoking is associated with poorer outcomes in those with AF, and cessation has been associated with reduced risk of stroke and cardiovascular events.[218][219] Optimal control of blood pressure may reduce AF recurrence and cardiovascular events.[220][221][222]

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