Practice Guidelines

Newly Detected Atrial Fibrillation: AAFP Updates Guideline on Pharmacologic Management


Key Points for Practice

• Rate control is strongly preferred to rhythm control in most patients, using nondihydropyridine calcium channel blockers and beta blockers.

• Rate control to less than 110 beats per minute at rest (lenient control) is recommended over rate control to less than 80 beats per minute (strict control).

• Long-term anticoagulation should be prescribed for all patients with atrial fibrillation, with the exception of those who have contraindications or a low stroke risk

From the AFP Editors

Atrial fibrillation, which can be paroxysmal or persistent, is a common arrhythmia, occurring in up to approximately 6 million adults in the United States. It is responsible for more than 750,000 hospitalizations, 130,000 deaths, and $6 billion in health care costs annually. Patients can present without symptoms or with any number of symptoms, including irregular heart rate, palpitations, and fatigue. Rate and rhythm control and thromboembolic episode prevention via medication, electrical cardioversion ablation, and surgery are possible management options.

The American Academy of Family Physicians (AAFP) has updated its 2003 guideline to provide guidance on atrial fibrillation treatment via medication in the primary care setting. The guideline focuses on adults with nonvalvular atrial fibrillation as diagnosed by electrocardiography; atrial fibrillation with a valvular or reversible etiology is not addressed in this update.


Rate control is strongly preferred to rhythm control in most patients, using nondihydropyridine calcium channel blockers and beta blockers, which are superior to digoxin. Rhythm control with amiodarone, dronedarone (Multaq), propafenone (Rythmol), or sotalol (Betapace) can be considered for persons in whom rate control is ineffective and based on symptoms, exercise tolerance, and patient preference. High-quality data indicate that there are fewer hospitalizations with rate control than with rhythm control. In addition, there are significant risks and

Author disclosure: No relevant financial affiliations.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of Practice Guidelines published in AFP is available at



Copyright © 2017 by the American Academy of Family Physicians.
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Aug 15, 2018

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