Scenarios
Most patients with a history of AF or AFL should be considered for referral to a cardiologist or an internist with an interest in cardiovascular disease for an expert opinion on management.
Patients ≤35 yr old with symptomatic AF should be referred to an arrhythmia specialist to rule out other forms of supraventricular tachycardia that may trigger AF and that would be best treated by radiofrequency ablation.
Patients who remain highly symptomatic despite multiple trials of antiarrhythmic drug therapy, or who remain unresponsive to, or intolerant of rate controlling therapies should be referred to an arrhythmia specialist for an expert opinion on management alternatives.