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Paroxysmal
 
 
 
 
 
 
 
Persistent
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Look for the presence of one of these severe symptoms
Hypotension
Heart failure
Angina pectoris

Severe symptoms absent:
No therapy needed


Severe symptoms present:

Attempt direct-current cardioversion
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Anticoagulation as needed based on the risk of stroke
Click here for the risk of stroke and anticoagulation therapy
Recommended in all cases except lone AF (I A)
Measure INR weekly initially, then monthly when stable
Reassess need for anticoagulation at periodic intervals
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  • Dabigatran may be used as an alternative to warfarin in those wdo don't have:
  • Prosthetic heart valve
  • Hemodynamically significant valve disease
  • Severe renal failure (creatinine clearance <15 mL/min) or
  • Advanced liver disease (impaired baseline clotting function).