Optimizing the management of atrial fibrillation: Focus on current guidelines and the impact of new agents on future recommendations

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia encountered in everyday clinical practice. It affects ∼2.3 million individuals in the United States, and the prevalence is expected to increase ∼2.5-fold over the next 40 years. Atrial fibrillation accounts for more than 2 million hospitalizations each year and contributes to nearly 67 000 deaths. Our understanding of the pathophysiology of AF has increased dramatically over the past few decades. Recent treatment guidelines have heightened our awareness of the challenges involved in the treatment of AF and provided useful recommendations for its diagnosis and management. Because AF is usually associated with multiple comorbid conditions, greater emphasis must be placed on individualizing treatment. This review focuses on current treatment guidelines for patients with AF, assessing the benefits and shortcomings of current pharmacologic options and discussing new agents and trials that may provide better opportunities to improve and individualize patient management.