Nonrheumatic atrial fibrillation: a brief overview.

Objective: To review the effectiveness of current approaches in the treatment of patients with nonrheumatic atrial fibrillation (NRAF).

Design: Review of the available English-language articles on the epidemiology, clinical consequences, management and prevention of stroke in patients with NRAF.

Results: The incidence of atrial fibrillation increases steadily in both sexes in relation to age. The clinical independent risk factors for NRAF are diabetes mellitus, hypertension, recent heart failure, valvular heart disease and myocardial infarction. The echocardiographic predictors are left atrial enlargement, reduced left ventricular function and left ventricular wall thickness. The clinical consequences of NRAF are increased risk of stroke, mortality and left ventricular dysfunction. The management of NRAF includes correction of cause, termination of acute episode, maintenance of sinus rhythm, ventricular rate control and prevention of systemic embolism.

Conclusion: NRAF is a common cardiac arrhythmia that is associated with high incidence of mortality and systemic embolism. Anticoagulation is effective in preventing embolism with acceptable risk of major bleeding. Acetylsalicylic acid is less effective but a reasonable alternative when anticoagulation is contraindicated.