What is the initial treatment for atrial fibrillation?

The initial treatment for atrial fibrillation primarily focuses on preventing thromboembolic events and controlling the heart rate or rhythm. Anticoagulation therapy is crucial because atrial fibrillation can lead to blood pooling in the atria, increasing the risk of clot formation. These clots can travel to the brain, resulting in a stroke. Therefore, initiating anticoagulation therapy is essential to reduce this risk, especially in patients who have been in atrial fibrillation for more than 48 hours or if the duration is unknown.

While cardioversion can be used to restore normal rhythm and pacing may help in specific situations, these interventions primarily address the rhythm disturbance rather than the immediate risk of thromboembolism associated with atrial fibrillation. Defibrillation is not indicated unless the patient is experiencing life-threatening arrhythmias.

In the context of treatment protocols, the stabilization of anticoagulation is prioritized before considering rhythm control strategies like cardioversion, particularly for patients with risk factors for stroke. Therefore, initiating anticoagulation therapy is a critical first step in the management of atrial fibrillation.