Most patients who come to see me want to get their heart rhythm back to normal, and with it the quality of life they used to enjoy. Catheter Ablation can be a great help for many, and I'm delighted to discuss whether this will be right for you in the clinic, as well going over all the modern approaches to AF. The principles of AF management focus on the key factors for the patient - preventing complications and long-term problems and treating important symptoms. No one approach is right for everyone, I take a personalised view that we should decide together on the best treatment strategy for you. Our first priority is to prevent strokes that may arise if the individual is higher risk, and this is done by anticoagulation. Aspirin does not in fact have benefits above the side-effect risks in preventing strokes in AF and can be avoided unless there is another reason to be taking this. We use the "CHADSVASC" score as a method of working out the rough risk of stroke, and I tend to use one of the non-vitamin K antagonist anticoagulants (NOACs) as these are really now the standard of care. Our second priority is controlling the rate that the heart is in during AF. This is often best done with a betablocker or calcium channel blocker. Digoxin can also be useful, particularly in combination with either one of the other medications. This not only helps with symptoms but helps reduce the risk of developing heart failure as a result of AF. Thirdly, control of the heart rhythm to prevent AF from happening can be provided either by drugs or by catheter ablation. There is increasing evidence that maintenance of sinus rhythm, which is best done by ablation, has benefits for both quality of life and in reducing heart failure. However, in many people, medication can be effective. In my own practice, I have been definitely moving ablation up the list and am keen to ablate early if possible (i.e. offer definitive treatment quickly), but this isn't suitable for everyone. Amiodarone and other antiarrhythmic medications are often prescribed to help regulate the heart's rhythm. While they can be very effective, they come with potential risks like all medicines. Some people taking amiodarone might experience side effects like fatigue, lung or liver problems, skin changes (such as turning bluish or sensitivity to sunlight), thyroid imbalances, and eye issues (cataracts are very common). These side effects really mean that I hate using it for patients in the long term, however, it can be very useful in the short term, especially in the time around the ablation. It's also important to remember that not every antiarrhythmic drug works the same way, and some may have different side effects. For example, other antiarrhythmics can sometimes even cause new or worsened irregular heart rhythms. However, for short- to medium-term use, many people get on well with a combination of, for example, diltiazem and flecainide. The downsides of antiarrhythmic medication really stimulated the development and refinement of ablation treatments. and ablation is a great treatment for many. However, pacemakers sometime have their uses, and this can be the right solution for many people, either in combination with ablation or on it's own.