Atrial fibrillation
This page features practical, evidence-based guidance for family physicians caring for patients with atrial fibrillation.
Decision-making guide
What is the target heart rate for patients with AF?
For symptomatic management of AF, a strict rate control strategy (resting heart rate less than 80 beats per minute) is reasonable (Class IIa, LOE: B).6 A lenient rate control strategy (resting heart rate less than 110 beats per minute) may be reasonable as long as patients remain asymptomatic and left ventricular systolic function is preserved (Class IIb, LOE: B).
Which patients need prolonged monitoring with an external ambulatory ECG monitor or implantable loop recorder (ILR)?
Initial cardiac monitoring and, if needed, prolonged monitoring with an ILR are reasonable to improve detection of AF in patients following a cryptogenic stroke or transient ischemic attack (TIA) (Class IIa, LOE: B). The recommended course of action is extended external ambulatory ECG monitoring for 30 days. If AF is not detected with external ambulatory monitoring, implantation of an ILR is reasonable (Class IIa, LOE: B).
Which patients with AF should be referred to cardiology/electrophysiology for antiarrhythmic drugs (AAD) or ablation?
Referral to cardiology/electrophysiology will depend on local cardiology expertise.
Ablation may be considered for:
- Younger patients
- Patients for whom AADs have been ineffective or not well tolerated
- Asymptomatic patients at increased risk of stroke (CHA2DS2-VASc score of 2 or greater)
These decision points, medication recommendations and considerations are excerpts from a decision-making guide developed by the AAFP.
Other resources
These resources are supported by an educational grant from the Bristol Myers Squibb and Pfizer Alliance.
Free on demand CME: Atrial fibrillation for family physicians
Atrial fibrillation (AFib) affects more than 10.5 million Americas—and that number is only climbing. By 2030, over 12 million people are projected to have AFib (a 14% increase in just five years), driven by an aging population and the rise of conditions like hypertension, diabetes and obesity.
AFib is complex but managing it doesn’t have to be. This enduring, self-study activity is designed to boost your knowledge, confidence and competence in caring for patients with AFib through shared decision-making.
Inside Family Medicine Podcast
In this episode of CME on the Go, Dr. Eddie Needham, MD, an experienced family medicine educator, discusses recent updates in the classification and management of atrial fibrillation. He outlines the new classification system introduced by the American College of Cardiology and the American Heart Association, including risk factors, and the importance of early rhythm control. He emphasizes the important role of lifestyle modifications and the influence of social determinants of health in treating atrial fibrillation. The conversation also includes practical strategies for patient counseling and shared decision-making.