Although many advances have been made in the treatment of atrial fibrillation (AF) that have changed the status quo of AF treatment, there are still many misconceptions about the treatment of AF that affect our management of AF. Overall there are the following points. 1, insufficient knowledge of the hazards of atrial fibrillation thromboembolism The most serious complication of atrial fibrillation is thromboembolism, especially stroke, foreign data show that the annual incidence of atrial fibrillation-related strokes is 4.5%; about 15% of the strokes are directly related to atrial fibrillation; the United States each year, there are about 75 to 100,000 strokes for the atrial fibrillation-related thromboembolism; atrial fibrillation leads to an increase in the risk of strokes with the increase in age. A retrospective survey of hospitalized cases of atrial fibrillation in some areas of China showed that the prevalence of stroke in patients with atrial fibrillation was 17.5%, and a case-control study of stroke in atrial fibrillation conducted by Hu Dayi et al. in 18 hospitals across the country showed that the prevalence of stroke in patients with atrial fibrillation in China was 24.8%. In addition, strokes caused by atrial fibrillation are more serious than atherosclerotic strokes, with a higher mortality rate, longer hospitalization time, and more severe residual limb dysfunction. In the past, paroxysmal AF was thought to be more likely to lead to thromboembolism than chronic AF, but the Framingham study showed that the risk of embolism from chronic AF was comparable to that of paroxysmal AF. A pooled analysis of five randomized clinical trials also showed that paroxysmal atrial fibrillation and chronic atrial fibrillation have a similar risk of stroke. 2. Irregular application of digitalis drugs A follow-up analysis of the AFFIRM study found a 41% increase in mortality in the digoxin group of patients with atrial fibrillation combined with congestive heart failure and a 37% increase in mortality in the digoxin group of patients with uncomplicated congestive heart failure, a result that persisted after controlling for comorbidities and propensity scores, across gender, and with or without heart failure. It was conclusively demonstrated that the application of digoxin to treat patients with atrial fibrillation would increase all-cause mortality, cardiovascular disease mortality, and arrhythmia mortality by 37%, 35%, and 61%, respectively. Casiglia E et al. found in a 12-year follow-up study of 2254 patients over 65 years of age that those taking digoxin had a higher mortality rate than those not taking it (58%, 49.5%, p < 0.0001), and that the former also had a higher cardiovascular mortality rate (21.5% , 17.7%; p < 0.0001).The SPORTIF IIIand V studies also confirmed that digoxin use was associated with mortality. The incidence of fatal myocardial infarction was higher in the digoxin group (8.6%, 5.7%; p = 0.026), as were sudden cardiac death and heart failure. Although digoxin was once widely used in patients with AF, studies suggest that it is ineffective for AF reversal, increases susceptibility to AF and AF recurrence, and has a limited effect on AF ventricular rate control, especially in patients with AF without heart failure, which increases the incidence of cardiovascular events and all-cause mortality, and it does not improve exercise tolerance and prognosis in patients with heart failure. Widespread and massive clinical use in the past stemmed from a general lack of awareness of its dangers. Clinicians should reposition the role of digoxin in the treatment of atrial fibrillation and be more cautious when prescribing digoxin to patients with atrial fibrillation. 3, the application of anticoagulant drugs is low The Chinese Medical Journal published an article found that 8 districts in the city of Beijing (Dongcheng District, Xicheng District, Haidian District, Chaoyang District, Chongwen District, Xuanwu District, Shijingshan District, and Fengtai District) selected 8 tertiary hospitals and 7 secondary hospitals (community health service centers). A uniform questionnaire was taken by internists to patients with nonvalvular atrial fibrillation in outpatient clinics or wards. Of the 583 patients, 75% originated from outpatient clinics, of which 64.3% originated from tertiary hospitals; 35.7% originated from community health centers. The results of the survey found that in the population of patients with atrial fibrillation at high risk of stroke, only 18.2% of patients taking warfarin; in the population of low risk of stroke, 21.3% of patients taking warfarin. The current status of anticoagulation therapy is not optimistic. In the survey, it was also found that one of the main reasons for the low rate of anticoagulation in patients with atrial fibrillation was that it was not recommended by the doctor, accounting for 78.6%. Other reasons were fear of bleeding, monitoring trouble, or the existence of contraindications to anticoagulation therapy. 4, excessive aspirin application In response to clinicians' common use of aspirin for atrial fibrillation thromboembolism, a Japanese study confirmed that the efficacy and safety of low-dose aspirin in preventing stroke in patients with low-level atrial fibrillation was not superior to that of the control group, and the trial was terminated prematurely due to the lack of difference in endpoint events between the two groups. A Danish cohort study that enrolled 132,172 patients with high-risk atrial fibrillation found that aspirin's effectiveness in preventing thromboembolism in high-risk patients with atrial fibrillation was consistent with no antithrombotic therapy. A real-world clinical meta-study that included 30 anticoagulation clinics and general outpatient clinics confirmed the ineffectiveness of aspirin for stroke prevention. This shows that aspirin is ineffective in the prevention of thromboembolism in atrial fibrillation, and clinicians should change their mindset that the preferred thromboembolism-preventive medications for patients with atrial fibrillation are warfarin and newer oral anticoagulants. 5, occasional atrial fibrillation long-term application of anti-arrhythmic drugs For patients with infrequent attacks of atrial fibrillation, symptoms may be heavier after the attack, the need for short-term control of the condition. It is not necessary to take drugs regularly for a long time to prevent its recurrence. Long-term oral Class I or Class III drugs to control atrial fibrillation that may only occur several times a year will not be worth the cost, but will cause adverse drug reactions and lead to unnecessary effects. As a result, the treatment can be resumed by taking the medication at once after the recurrence of atrial fibrillation or by intravenous drug administration. In conclusion, in recent years, the treatment of atrial fibrillation has made a lot of progress, and many new therapeutic techniques and therapeutic means need to be confirmed and expanded by future clinical research. As for the many misunderstandings in the treatment of atrial fibrillation, we should keep abreast of the times, follow the pace of the guideline, and meet the treatment and management of atrial fibrillation patients with a new concept.