For regular, moderate drinkers, total abstinence from alcohol reduces but does not usually eliminate atrial fibrillation recurrences.
Up to two-thirds of patients experiencing acute onset (shorter than 36 hours) of atrial fibrillation will spontaneously revert to sinus rhythm without the need for cardioversion. If atrial fibrillation has been present for more than a week, spontaneous conversion is unlikely and cardioversion may be considered for symptomatic patients.
Patients with atrial fibrillation who had stable coronary disease or who were at least 1 year from most recent coronary stent or coronary bypass surgery appeared to have greater risk than benefit from the combination therapy of rivaroxaban and an antiplatelet agent.
An effective treatment strategy in select patients with symptomatic but rare (a few times a year) episodes of atrial fibrillation is on-demand pharmacologic cardioversion. In patients without coronary or structural heart disease, flecainide (200–300 mg) or propafenone (450–600 mg) in addition to a beta-blocker or nondihydropyridine calcium channel blocker is taken as a single dose at the onset of symptoms.
The primary benefit of catheter ablation in patients with atrial fibrillation is an improvement in quality of life. In the CABANA trial, there was no difference in the primary endpoint of death, disabling stroke, serious bleeding, or cardiac arrest in patients randomized to catheter ablation versus medical therapy as first treatment for symptomatic atrial fibrillation.