[Management of a first recent episode of atrial fibrillation in clinical practice]. / Que faire devant un premier passage récent en fibrillation atriale?

Atrial fibrillation (AF) is the most frequent supraventricular arrhythmias with an approximative prevalence of 1 % in the general population and above 6 % in the elderly. Management of a first AF episode is different depending on the clinical status of patients. Practice 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 patients condition. In case of the AF reduction decision, anticoagulation must be tailored preliminary to this reduction. AF recurrence rate varies depending on the patients condition, and the risk of stroke assessed by the CHADS(2) score might be similarly considered for both paroxysmal and persistent AF.