What should be done first when treating atrial fibrillation?

When treating atrial fibrillation, starting anticoagulation therapy is crucial because it addresses the significant risk of thromboembolic events associated with this cardiac arrhythmia. Atrial fibrillation can lead to stagnant blood flow in the atria, increasing the likelihood of clot formation, particularly in the left atrial appendage. These clots can dislodge and subsequently cause a stroke.

By initiating anticoagulation, healthcare providers help mitigate the risk of such complications. This is often a priority before considering other interventions like rhythm control strategies (such as anti-arrhythmic medications or electrical cardioversion), especially if the onset of atrial fibrillation has been longer than 48 hours or if the patient has significant underlying comorbid conditions. Therefore, ensuring that the patient is anticoagulated first is a foundational step in safely managing the condition before addressing the rhythm abnormalities.