Atrial fibrillation: how should it be treated?

istorical Aspect In 1827 Robert Adams was probably the first person to recognize Atrial Fibrillation (AF) clinically as a sign of mitral stenosis. Hope in 1839 identified irregular pulse in association with mitral stenosis. Etienne Marcy in 1863 published a tracing of atrial fibrillation from a patient with mitral stenosis. Arthur Cushney described it in 1899. Initially AF was termed as Delerium cordes. Sir Thomas lewis at University college hospital, London recorded atrial fibrillation with electrocardiograph in 1909. In 1935 Bonillanad found that digitalis reduced ventricular rate dramatically even though irregularity of pulse persisted. In 1969, Lown recommended cardioversion of atrial fibrillation. Introduction The tachyarrhythmias are either supraventricular or ventricular. Atrial fibrillation is the most common supraventricular tachyarrhythmia encountered by the practicing physician. Atrial fibrillation can be dangerous in patients with short accessory pathways. The rapid fibrillatory waves are conducted along the accessory pathway when AV node is blocked by drugs like verapamil, beta-blockers or digoxin. The rapidly conducted fibrillatory waves across the accessory pathway may result into ventricular fibrillation and sudden death.