Clinical Practice Guideline

Atrial Fibrillation

Management of Newly Detected Atrial Fibrillation

(Jointly Developed, April 2003, Reaffirmed 2008)

The guideline, Management of Newly Detected Atrial Fibrillation: A Clinical Practice Guideline, was developed by the American Academy of Family Physicians and the American College of Physicians. It was approved by the AAFP Board of Directors in 2003 and was published in the Annals of Internal Medicine in 2003. It was reaffirmed in 2008 by the AAFP Board of Directors.

Key Recommendations

  • Rate control with chronic anticoagulation is recommended for the majority of patients with atrial fibrillation. Rhythm control is appropriate when based on special considerations such as patient symptoms, exercise intolerance, and patient preference.
  • Patients with atrial fibrillation should receive chronic anticoagulation with adjusted-dose warfarin, unless they are at low risk for stroke or have a specific contraindication to warfarin.
  • For patients with atrial fibrillation, the following drugs are recommended: atenolol, metoprolol, dilitiazem, and verapamil. Digoxin should only be used as a second-line agent for rate control as it is only effective at rest.
  • Most patients converted to sinus rhythm from atrial fibrillation should not be placed on rhythm maintenance therapy since the risks outweigh the benefits. In a selected group of patients whose quality of life is compromised by atrial fibrillation, the recommended pharmacologic agents for rhythm maintenance are amiodarone, disopyramide, propafenone, and sotalol. The choice of agent predominantly depends on specific risk of side effects based on aptient characteristics.

See the full recommendation for further details.


These guidelines are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute the individual judgment brought to each clinical situation by the patient’s family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These guidelines are only one element in the complex process of improving the health of America. To be effective, the guidelines must be implemented.