Atrial fibrillation (AF) is one of the most common clinical arrhythmias, and Framingham’s study suggests that the prevalence of AF in the population is about 0.5%, and increases with age; it can be as high as 6% or more in people over 60 years of age. Conservative estimates suggest that there are approximately 8 million people with AF, and this number will continue to rise as industrialization and aging accelerate. Although the development of radiofrequency ablation for atrial fibrillation is rapid, drugs are still the most important treatment for atrial fibrillation. Unfortunately, there are still many misconceptions about the drug treatment of atrial fibrillation, which are briefly summarized below. Misconception 1: Lagging treatment concepts The 2010 SEC AF Guidelines ushered in a new era in which mortality reduction is the direct treatment goal, i.e., to fundamentally reverse the harms of atrial fibrillation and achieve the “three lowers and three highs”: reduce mortality, hospitalization, and stroke rates, and improve quality of life, cardiac function, and activity tolerance. Driven by the new therapeutic goals, AF treatment strategies have been reoriented to anticoagulation, ventricular rate or rhythm control therapy, and upstream substrate therapy. Since the most significant hazard of AF is thromboembolism, especially cerebral embolism, which is the most immediate cause of death in patients with AF. Because of its effectiveness in reducing the incidence of stroke, and thus mortality, anticoagulation has jumped to the top of the list of total treatment strategies. On the other hand, antiarrhythmic therapy for atrial fibrillation has gradually taken a tolerant attitude, shifting to alleviate symptoms and reduce complications as the main goal of treatment, loosely controlling the heart rate, moderately maintaining the sinus rhythm, and applying antiarrhythmic drugs with more safety than effectiveness. Myth 2: Insufficient anticoagulation intensity and low warfarin use There is no risk stratification according to the CHA2DS2 score during the treatment of atrial fibrillation, and there is excessive concern about the risk of bleeding with warfarin, and for intermediate-risk and high-risk embolism patients, the use of warfarin is extremely low, and even if it is used, the rate of INR attainment is very low. Actual studies have shown that, as long as the warfarin dose is carefully adjusted (keeping the INR at 2.0 to 3.0), warfarin can be safely used in patients of all ages with atrial fibrillation, including those over 90 years of age, and there is no significant difference in the risk of minor bleeding compared with the application of aspirin, and the risk of fatal high-risk, such as intracranial hemorrhage, is even lower than that of the relative. Myth three: do not pay attention to the type of atrial fibrillation, the structure of the heart and the presence or absence of organic heart disease In clinical practice, atrial fibrillation episodes generally start from atrial premature beats to frequent episodes of atrial premature with short bursts of atrial tachycardia episodes, which can be paroxysmal (paroxysm) atrial fibrillation, and then paroxysmal atrial fibrillation develops into persistent atrial fibrillation, and ultimately develops into permanent (permanent) atrial fibrillation, which is the first time that atrial fibrillation is seen. This is often referred to as the “three P’s” classification of AF. The ESC 2010 updated guidelines classify AF into five categories, namely, first diagnosed AF, paroxysmal AF, persistent AF, long lasting persistent AF, and permanent AF. It is important to pay attention to AF typing and understand the structure of the heart, especially the presence or absence of heart valve disease, left atrial size, and whether it is combined with hyperthyroidism, before treatment; it is important not to blindly perform resuscitation or ventricular rate control without a comprehensive assessment. Different interventions should be made with knowledge of the type of atrial fibrillation and the characteristics of the episodes, as well as the concomitant cardiac conditions. It is inappropriate for some physicians to blindly reset or control the heart rate without understanding the condition and its classification. It is important to understand the classification and adopt different interventions according to the classification and characteristics of the attack. Myth 4: Are the benefits of resetting and maintaining sinus rhythm equivalent in different patients? The harms of AF are well recognized, and in most cases these harms can only be optimally controlled and corrected when AF is reversed and sinus rhythm is maintained. There is a certain amount of misinformation in between that confirms that treatment for ventricular rate control in AF is equal to or superior to treatment for reversal of sinus rhythm. However, subgroup analysis of the AFFIRM study showed that maintaining sinus rhythm may have better quality of life, but at present, due to the insufficient effectiveness of antiarrhythmic drugs in the reversal and maintenance of sinus rhythm in atrial fibrillation and a variety of adverse effects, the choice of the strategy of reversal and maintenance of sinus rhythm should be considered with care: paroxysmal atrial fibrillation, atrial fibrillation without organic heart disease, and atrial fibrillation in patients with a relatively young age should be given active For paroxysmal atrial fibrillation, atrial fibrillation without organic heart disease, and atrial fibrillation in younger patients, active treatment should be given, and drugs should be actively used to convert it to sinus rhythm and actively maintain it. Atrial fibrillation of longer duration, accompanied by significant organic heart disease, the age of patients, when the heart has obvious anatomical and electrical remodeling, may be converted to sinus and maintain the sinus rhythm of the treatment are difficult, can not be forced to do. Myth 5: Atrial fibrillation treatment is not differentiated when accompanied or not accompanied by heart failure Many domestic doctors have such a misunderstanding, in the face of paroxysmal atrial fibrillation patients, whether or not they are combined with heart failure, as long as the ventricular rate is fast and need medication to control the ventricular rate, it is always the first choice of static push of cediran, because cediran can inhibit the conduction of the atrioventricular node, so that the ventricular rate decreases markedly, and the restoration and maintenance of the sinus rhythm, the majority of the use of amiodarone. However, in recent years, the international guidelines for the treatment of atrial fibrillation do not recommend this for the pharmacologic treatment of ventricular rate control in paroxysmal atrial fibrillation without heart failure. Pharmacological treatment of rapid ventricular rate in atrial fibrillation without heart failure, regardless of whether it is paroxysmal, persistent or persistent atrial fibrillation, Class I recommends oral beta-blockers or calcium antagonists to control the patient’s heart rate at rest or after the activity of low blood pressure or rapid ventricular rate can be accompanied by the application of these drugs in the intravenous preparation of the need for emergency treatment. Pharmacologic therapy for ventricular rate control in these patients digitalis and amiodarone are recommended only as Class II. Secondly, for patients without organic heart disease and with normal cardiac function, reversal of atrial fibrillation propafenone is more effective than amiodarone. Myth six: to the atrium without thrombus and no cardiac insufficiency are atrial fibrillation resuscitation treatment This view is incorrect. Generally speaking, if the duration of persistent atrial fibrillation is more than one year, it is not suitable for reset therapy. In the process of clinical treatment, we all have this experience, with the prolongation of paroxysmal atrial fibrillation episodes, the subsequent episodes of prolonged time, and the frequency of more accelerated, this is the atrial fibrillation “concatenation phenomenon”. The study also found that long-term atrial fibrillation can also make the sinus node function is impaired, some patients can occur sick sinus node syndrome, such as atrial fibrillation rewiring therapy for such patients, can occur sinus bradycardia, sinus arrest and other life-threatening arrhythmias. The judgment of the time of occurrence of atrial fibrillation is very important. It is generally believed that one of the following conditions is not suitable for atrial fibrillation resuscitation therapy: ① left atrial diameter ≥ 50mm; ② atrial fibrillation ventricular rate is slow, about 60 times / min; ③; cardiac function in the Ⅱ class or more; ④ atrial fibrillation f-wave universal leads are small; ⑤ thrombus and hyperthyroidism signs; ⑥ rheumatic heart valve disease history > half a year or rheumatism, other causes of atrial fibrillation history of > 1 year; ⑦ suspected of sinus syndrome or conduction disorders; ⑧ sick sinus syndrome or conduction disorders; (8) the history of atrial fibrillation. or conduction disorders; ⑧ acute infections and electrolyte disorders. Myth 7: Episodic atrial fibrillation long-term AAD to maintain sinus rhythm For patients with infrequent atrial fibrillation, the symptoms may be more severe after the attack, and it is necessary to control the condition for a short period of time. It is not necessary to take medication regularly for a long period of time to prevent its recurrence. Long-term oral administration of Class I or Class III drugs to control atrial fibrillation, which may only occur a few times a year, does not pay for itself, and it can be treated again after the crime is committed. Thus, it is possible to use drugs that can be taken immediately after the recurrence of atrial fibrillation or to administer drugs intravenously for resumption of treatment. Myth 8: to pay attention to the combined application of drugs Drug treatment of atrial fibrillation, should pay attention to the combined application of drugs.AAD combination method is more, almost any two drugs with no absolute contraindications. Two different types of AAD joint application, anti-arrhythmic effect can be superimposed, and due to the reduction of the dose of the joint application, the risk of side effects is also reduced, such as a small dose of digitalis and β-blocker joint application, can improve the ventricular rate control of atrial fibrillation, but also to reduce the single dose of a larger dose of the drug may be the occurrence of adverse reactions. In addition, when applying AAD for the treatment of atrial fibrillation, attention should be paid to the safety of other drugs used in combination. For example, when amiodarone is used in combination with warfarin, it can inhibit the metabolism of warfarin, so when both are taken together, the dose of warfarin should be appropriately reduced according to the results of the INR measurement. Similarly, digoxin and amiodarone Myth 9: Lack of a holistic view, ignoring the original disease Atrial fibrillation is an arrhythmia, not an independent disease. It may have different etiologies in different patients, and the types of comorbidities, cardiac function status, and age vary widely. Therefore, it is important to assess the patient’s condition in a comprehensive manner, and the aims and methods of treatment vary from patient to patient. In the treatment of any disease, attention should be paid to both the cause and the symptom in order to achieve better clinical results, and the treatment of atrial fibrillation is no exception. The treatment of atrial fibrillation is no exception. The treatment of atrial fibrillation should not only focus on the atrial fibrillation, but also on the possible causes of atrial fibrillation. Clinicians should pay attention to these causes when treating atrial fibrillation. Clinical common atrial fibrillation combined with infections, ionic disorders, heart failure, etc., without correcting these factors, atrial fibrillation is difficult to effectively control, simply increase the dosage of AAD, but the side effects increase. Misconception 10: upstream substrate treatment is not grasped ESC2010 upstream substrate treatment of atrial fibrillation written into the guidelines for coronary artery disease combined with atrial fibrillation, statins should be used; combined with hypertension, heart failure atrial fibrillation should be used ACEI or ARB. but if there is no cardiovascular disease itself for the indications, for the idiopathic atrial fibrillation without organic heart disease, and the application of the above drugs solely for the purpose of preventing atrial fibrillation, then it will not be able to play a due role in treatment (IIIc.). effect (IIIc). In the secondary prevention of atrial fibrillation, clinical trials have not confirmed that the above drugs can prevent atrial fibrillation episodes and do not have to increase the unnecessary economic burden. In conclusion, the treatment of atrial fibrillation should be kept up to date with the times and individualized on the basis of following and understanding the guidelines.