This National Institute for Health and Care Excellence (NICE) guideline covers diagnosing and managing atrial fibrillation in adults. It aims to ensure that people receive the best management to help prevent harmful complications, in particular stroke and bleeding.
Offer people with atrial fibrillation a personalised package of care. Ensure that the package of care is documented and delivered, and that it covers:
Refer people promptly at any stage if treatment fails to control the symptoms of atrial fibrillation and more specialised management is needed. [new 2014]
Use the CHA2DS2-VASc stroke risk score to assess stroke risk in people with any of the following:
Use the HAS-BLED score to assess the risk of bleeding in people who are starting or have started anticoagulation. Offer modification and monitoring of the following risk factors:
Do not offer aspirin monotherapy solely for stroke prevention to people with atrial fibrillation. [new 2014]
Offer rate control as the first‑line strategy to people with atrial fibrillation, except in people:
If drug treatment has failed to control symptoms of atrial fibrillation or is unsuitable:
 The Guideline Development Group defined 'promptly' as no longer than 4 weeks after the final failed treatment or no longer than 4 weeks after recurrence of atrial fibrillation following cardioversion when further specialised management is needed.
 For more information on left atrial catheter ablation see Percutaneous balloon cryoablation for pulmonary vein isolation in atrial fibrillation (NICE interventional procedure guidance 427), Percutaneous endoscopic catheter laser balloon pulmonary vein isolation for atrial fibrillation (NICE interventional procedure guidance 399) and Percutaneous (non-thoracoscopic) epicardial catheter radiofrequency ablation for atrial fibrillation (NICE interventional procedure guidance 294). For more information on left atrial surgical ablation without thoracotomy see Thoracoscopic epicardial radiofrequency ablation for atrial fibrillation (NICE interventional procedure guidance 286).
Atrial fibrillation is the most common sustained cardiac arrhythmia, and estimates suggest its prevalence is increasing. If left untreated atrial fibrillation is a significant risk factor for stroke and other morbidities. Men are more commonly affected than women and the prevalence increases with age.
The aim of treatment is to prevent complications, particularly stroke, and alleviate symptoms. Drug treatments include anticoagulants to reduce the risk of stroke and antiarrhythmics to restore or maintain the normal heart rhythm or to slow the heart rate in people who remain in atrial fibrillation. Non‑pharmacological management includes electrical cardioversion, which may be used to 'shock' the heart back to its normal rhythm, and catheter or surgical ablation to create lesions to stop the abnormal electrical impulses that cause atrial fibrillation.
This updated guideline addresses several clinical areas in which new evidence has become available, including stroke and bleeding risk stratification, the role of new antithrombotic agents and ablation strategies.
The recommendations apply to adults (18 years or older) with atrial fibrillation, including paroxysmal (recurrent), persistent and permanent atrial fibrillation, and atrial flutter. They do not apply to people with congenital heart disease precipitating atrial fibrillation.
You can read the guideline on NICE's website.