Citation : Sophie Gomes, Laure Champ-Rigot, Anthony Foucault, Arnaud Pellissier, Alain Lebon, Patrice Scanu, Paul Milliez
Atrial fibrillation (AF) is the most frequent supraventricular arrhythmia with an approximative prevalence of 1 % in the general population and above 6 % in the elderly. After a first AF diagnosis, the hospitalization rate is markedly increased. Management of a first AF episode is different depending on the clinical status of patients. Practical guidelines developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society are available for the management of these patients. A four-step decisional scheme must be followed in the management of a first recent AF episode: need for a short- and long-term anticoagulation, define a rythmologic strategy (rhythm or rate control), select the weapon (drug, device or ablation) and reconsider the strategy if needed. After a first uncomplicated paroxysmal AF episode, guidelines recommend that prescription of antiarrhythmics must be avoided and anticoagulation is optional. After a first persistent AF episode, guidelines recommend to either respect or reduce the arrhythmia. Prescription of antiarrhythmics and anticoagulation is also optional depending on the patient’s condition. In case of the AF reduction decision, anticoagulation must be tailored preliminary to this reduction. AF recurrence rate varies depending on the patient’s condition, and the risk of stroke assessed by the CHA2DS2-VASc score might be similarly considered for both paroxysmal and persistent AF.