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pandora necklaces Summary pointsAtrial fibrillation is common and highly variable in its clinical presentation and evolution; it causes substantial morbidity and mortality, including impaired quality of life, heart failure, systemic emboli, and strokeThe first priority is to control heart rate (if tachycardia is present) and provide adequate antithrombotic treatment for preventing complications of embolismPatients with moderate to high risk of stroke require warfarin long term for preventing emboli; aspirin is adequate in patients with low risk of strokeWhen a patient should but cannot take warfarin, aspirin plus clopidogrel can be an intermediate optionFor long term treatment of atrial fibrillation, rate control matches rhythm control in terms of mortality and major cardiovascular events but has fewer adverse events related to the treatment and fewer hospital admissionsIf antiarrhythmic drugs fail to maintain sinus rhythm, percutaneous catheter ablation is an alternative for rhythm controlAtrial fibrillation is the commonest sustained arrhythmia encountered in clinical practice. In recent years, publication of several randomised controlled trials and meta analyses have improved our understanding of the advantages and inconveniences of rate and rhythm control strategies, and effective, new non pharmacological treatments have been introduced. New antiarrhythmic and anticoagulant drugs are expected in the near future.Clinical manifestations of atrial fibrillation: what is important to know?Atrial fibrillation is characterised by a chaotic electrical activity in the atria that induces an irregular and usually rapid contraction of the ventricles (figure 1) pandora necklaces.