Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. It places an enormous burden on the patients, caregivers, and the society at large. While the main themes in the care of an AF patient have not changed over the years and continue to focus on stroke prevention, control of the ventricular, rate and rhythm maintenance, there have been a number of new developments in each of these realms. This paper will discuss the “hot” topics in AF in 2012 including new and upcoming medical and invasive management strategies for this condition. 1. Introduction “There is no other serious cardiac disorder which can be so speedily benefited as the well-managed case of auricular fibrillation…the most reliable preparation to use is a fresh and known tincture of digitalis.” This quote from Clinical Disorders of the Heart Beat by Lewis published in 1925 [1] could not be further from the truth in 2012. With the multitude of new therapies introduced and in development to address various clinical implications of this most common sustained rhythm disorder, it is becoming a daunting task to select the right approach to each individual patient. Atrial fibrillation (AF) is responsible for most arrhythmia-related hospital admissions [2] and is the most common cause of ischemic stroke [3]. Furthermore, AF carries a tremendous negative impact on the quality of life and is associated with increased mortality [4]. Its prevalence is rising in our ageing society [5, 6] and so does the expense related to its management [7] and productivity lost among the suffering patients [8]. Decisions that need to be made in each AF patient care include selection of rhythm control or the more conservative control of the ventricular rate and selection of stroke prevention strategy. At each step the clinician needs to decide between medical and invasive solutions. Since AF is frequently associated with other comorbid conditions, these need to be addressed as well. Clinical practice guidelines developed by various professional societies attempt to help physicians select the right therapies for the right AF patients. Unfortunately, the many nuances of AF presentation and available therapies complicate clinical decision-making, guidelines lag behind new clinical developments, and few mechanisms are in place to translate guidelines into standards of care. The purpose of this paper is to discuss the “hot” topics in AF care in 2012. 2. Preventing Embolic Sequelae Prevention of embolic complications is the most important aspect of care for AF patients. These range from transient ischemic
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