Atrial fibrillation (AF) is the most common cardiac arrhythmia seen in clinical practice, affecting approximately 2.5 million persons in the U.S. AF is not only common but also carries significant risks of mortality and morbidity, raising the risk of stroke more than five-fold and contributing to an estimated 15-20% of strokes annually in the U.S. Even patients with AF who do not suffer a stroke often experience diminished quality of life and require frequent hospitalization.

This appraisal will evaluate the evidence on the comparative risks, benefits, and cost-effectiveness of management strategies for patients with AF. We will include in the scope of the appraisal:

• Antiarrhythmic drug therapy to return the heart to sinus rhythm
• Radiofrequency catheter ablation to terminate AF and prevent further episodes
• Minimally-invasive surgical techniques to terminate AF and prevent further episodes
• Aspirin, warfarin, and dabigatran for anticoagulation to prevent strokes
• The WATCHMAN left atrial appendage occlusive device to prevent strokes