Atrial fibrillation is an arrhythmia characterized by rapid disordered excitation and ineffective contraction of the atria, and is one of the most common arrhythmias in clinical practice. The normal heart consists of atria and ventricles, which contract in a coordinated manner under the control of normal sinus rhythm, and the atria play an auxiliary pumping function to the ventricles, so that the heart can work regularly and efficiently to meet the needs of the body. Atrial fibrillation patients with atrial beating disorders lead to overall heart beating disorders and progressive decline in cardiac function, resulting in a series of clinical manifestations and harm: 1, affecting the quality of life and work: general atrial fibrillation patients will have palpitations, dizziness, shortness of breath, and so on, and therefore do not feel comfortable, the quality of life, the quality of work will be affected. Especially the heart function is relatively poor, daily life can not be competent. Some patients with atrial fibrillation have severe symptoms, such as fatigue, dyspnea, fainting, etc. Those with underlying cardiac insufficiency can cause acute pulmonary edema. Studies have shown that quality of life scores of patients with AF are much lower than those of age-matched healthy individuals. Quality of life is affected to a greater extent in patients who are female, younger than 69 years of age, have a long duration of atrial fibrillation (more than one month), and have decreased activity tolerance. Recent studies have shown that older patients with atrial fibrillation also have significantly worse cognitive function than healthy people in the same age group, suggesting that atrial fibrillation is a risk factor for dementia. This may be related to cerebral embolism, another hazard of more serious atrial fibrillation, mentioned below. Thrombosis and embolism: This is the most serious complication of AF. Atrial fibrillation atrial loss of contraction function, blood easily in the atrium stagnation and the formation of blood clots, blood clots can be dislodged with the blood to all parts of the body, can cause kidneys, liver, intestinal blood vessel arteries and other embolisms, the more serious and common is to lead to cerebral embolism (i.e., stroke, hemiplegia), limb arterial embolism (the serious cases and even need to amputate the limbs). In patients with atrial fibrillation without other diseases who are younger than 60 years old, the annual incidence of stroke is about 1%, while in patients over 60 to 75 years old, the annual incidence of stroke is 2%. If accompanied by other embolic risk factors. The annual incidence of stroke can be up to 4%, which is 5-6 times of normal people. Moreover, stroke caused by atrial fibrillation has a high disability rate and high mortality rate, and is the most important cause of death in patients with atrial fibrillation. Meanwhile, asymptomatic cerebral embolism in people with atrial fibrillation is significantly associated with dementia. Risk factors for cerebral embolism in atrial fibrillation are: past history of embolism, hypertension, diabetes mellitus, coronary artery disease, heart failure, left atrial enlargement, and age over 65 years old. 3, to cardiac insufficiency: normal heart contraction is very regular: atrial contraction first, ventricular contraction, very coordinated, the heartbeat is 60 ~ 100 times / minute. Atrial fibrillation with irregular heartbeat, on the one hand, with rapid ventricular rate response when the heartbeat is greater than 100 times / minute, over time will lead to arrhythmogenic cardiomyopathy, resulting in cardiac insufficiency; on the other hand, due to the atrial and ventricular contraction of the uncoordinated, the heart’s ejection capacity can be reduced by 30%. If the original cardiac insufficiency, the condition will be significantly aggravated, and even heart failure. At the same time, heart failure and make the atrial pressure rise and activate the sympathetic nervous system, promote atrial fibrosis, prompted by atrial fibrillation attacks, the formation of atrial fibrillation and heart failure mutually reinforcing vicious circle. 4. Increased mortality: Many studies have shown that atrial fibrillation is a risk factor for increased mortality. In the absence of other cardiovascular diseases, atrial fibrillation can increase the mortality rate by a factor of one. When combined with heart failure, the mortality rate of people with atrial fibrillation is 2.2 times higher than that of people without atrial fibrillation, and 1.8 times higher than that of women. Therefore, in terms of the harmful results produced by atrial fibrillation, atrial fibrillation is a kind of malignant arrhythmia. According to conservative estimates, there are currently about 9 million cases of atrial fibrillation in China, accounting for the world’s largest absolute number, of which more than 3 million cases of paroxysmal and unexplained atrial fibrillation are in need of priority intervention. It is expected that in 2050, the total number of patients with atrial fibrillation worldwide will increase by at least three times compared with the present. The incidence of atrial fibrillation is high and harmful, so it is important to actively and effectively prevent and treat atrial fibrillation. First of all, let’s talk about preventive measures: First, control high-risk factors. For example: hypertension, adhere to the medication, blood pressure to meet the standard; heart valve disease, timely treatment. Coronary heart disease, diabetes, timely control can reduce the occurrence of atrial fibrillation. High blood fat, the latest research shows that lowering blood fat is helpful in preventing atrial fibrillation. Second, develop a good lifestyle. Regular life, balanced diet, do not smoke, less alcohol, less stimulating things to eat, such as strong tea, coffee drinking. Third, control your weight. People with a large body mass index have a higher chance of developing atrial fibrillation. Obese people themselves are also prone to high blood pressure and high blood fat, which are associated with atrial fibrillation. Before talking about the treatment measures of atrial fibrillation, let’s first understand the clinical classification of atrial fibrillation and some current understanding of its occurrence mechanism! According to the characteristics of the onset of atrial fibrillation, atrial fibrillation is divided into four categories: 1. Primary atrial fibrillation: refers to the first discovery of atrial fibrillation. Patients may have symptoms, or no symptoms, can be manifested as paroxysmal atrial fibrillation, persistent atrial fibrillation or permanent atrial fibrillation. 2, paroxysmal atrial fibrillation: refers to the occurrence of atrial fibrillation duration of ≤ 7d, most of the 48h, most of this type of atrial fibrillation does not need drugs or electrical reversal therapy, can be restored to sinus rhythm. 3, persistent atrial fibrillation: refers to atrial fibrillation duration > 7 days, no self-limiting, need drugs or electrical reversal to restore sinus rhythm. 4, permanent atrial fibrillation: refers to atrial fibrillation with drugs or electrical reversal can not be restored to sinus rhythm, or reversed to sinus rhythm can not be maintained with drugs. Chronic atrial fibrillation: persistent atrial fibrillation for more than 1 year and permanent atrial fibrillation with ineffective drug/electrical reversal. According to the presence or absence of organic heart disease and risk factors classification: 1, organic heart disease combined with atrial fibrillation, such as wind heart disease, hypertension, coronary heart disease, congenital heart disease, etc.. Isolated atrial fibrillation: atrial fibrillation at the age of <60 years without any cardiovascular disease and other risk factors. Familial atrial fibrillation: atrial fibrillation occurs in family members with family history. The mechanism of atrial fibrillation has not yet been fully elucidated. It has experienced "multiple microwave refractoriness", "rapid release impulse foci", "localized venous foci driven with fibrillation-like conduction" to the recent "pulmonary vein - left atrial refractoriness". Left atrial refractoriness" and other theories. The common thread is that the generation of AF requires both "focal triggering" and "abnormal matrix maintenance". It is generally believed that the trigger is the cause and the abnormal matrix is involved in the maintenance of AF. It is now believed that both factors are usually located in the pulmonary veins and the left atrium. Today's radical treatments for AF are based on these recent theories. At this point, we can also see that the case described above is a paroxysmal atrial fibrillation (primary) with hypertensive cardiac changes, which is symptomatic and recurrent during the onset of atrial fibrillation and cannot be converted to sinus. Long-term development brings the risk of reduced cardiac function and the formation of blood clots and embolism. So, what are the current methods of treatment for atrial fibrillation? Atrial fibrillation treatment purpose: 1, restore sinus rhythm: is the best method of atrial fibrillation treatment, only to restore sinus rhythm, in order to achieve the purpose of complete treatment of atrial fibrillation, so any atrial fibrillation patients should try to restore the sinus rhythm of the treatment method. 2.Control the fast ventricular rate: for patients with atrial fibrillation who cannot restore sinus rhythm, drugs can be applied to reduce the fast ventricular rate. 3.Prevent thrombosis and stroke: In atrial fibrillation, if sinus rhythm cannot be restored, anticoagulant drugs can be applied to prevent thrombosis and stroke. Treatment of atrial fibrillation: I. Restoration and maintenance of sinus rhythm: 1. Drugs to restore rhythm: for the treatment of paroxysmal and persistent atrial fibrillation. Maintaining sinus rhythm helps to eliminate symptoms, reduce embolic events and reduce or eliminate atrial remodeling. Traditional medications include class Ia, Ic and class III antiarrhythmics. If the duration of atrial fibrillation does not exceed 48h, the effective rate of drug resuscitation is 6o%~9o%; if the duration of atrial fibrillation is longer, the effect of drug resuscitation decreases gradually, and can be reduced to 10%. Commonly used drugs are: cardioplegia, quinidine, procainamide, amiodarone and so on. Among them, amiodarone (ketorolac) is by far the most commonly used, more effective drugs to reset and maintain sinus rhythm. Medical guidelines state that amiodarone is the drug of choice for resetting rhythm in people with definite heart disease, especially acute myocardial ischemia or heart failure or left ventricular hypertrophy, and amiodarone is also chosen in patients with mild or moderate heart disease when other drugs are ineffective. Ibutilide is a new antiarrhythmic drug that has been used in recent years to reset recently occurring atrial fibrillation with rapid onset of action. When currently available for intravenous use only. Dofetilide, a more specific antiarrhythmic drug, has been used only in recent atrial fibrillation. It can be used to reset atrial fibrillation and maintain sinus rhythm, and can be taken orally, but the therapeutic range of this drug is narrower, and it can cause malignant ventricular arrhythmias, so its clinical application is limited. Sotalol, mainly applied to maintain sinus rhythm, is not applicable to patients over 75 years of age, patients with manifestations of heart failure, angina pectoris, myocardial infarction within 4 weeks, and chronic lung disease. Overall speaking, the success rate of drug resumption and maintenance of sinus rhythm is low, the recurrence rate is high, and itself has the effect of arrhythmia, poor adherence of the elderly patients, is not the root of atrial fibrillation. 2, electrical reset: for emergency reset hemodynamically unstable patients or elective alternative drug reset. Generally use direct current resuscitation, resuscitation success rate of 70% ~ 90%, after electric resuscitation part of the patient can maintain sinus rhythm, but the recurrence rate is high. Electrical resuscitation need to pay attention to: no sick sinus syndrome, hypokalemia, digitalis poisoning. Oral warfarin anticoagulation for 3 weeks before resuscitation, continue to use 4 weeks after resuscitation. Atrial fibrillation electrically reset is usually carried out under general anesthesia, recently there are also in the awake sedation conditions. 3, Surgery: through open-heart surgery using cutting - stitching technology, blocking the atrial folding pathway leading to atrial fibrillation, but the selection of the indications for the case of high requirements, the difficulty of surgical operation, complications, and the possibility of postoperative recurrence of a large number of problems, to a certain extent, restricting the popularization and application of it. 4, radiofrequency ablation: radiofrequency ablation for atrial fibrillation is a breakthrough, is a non-drug to restore the sinus rhythm of the ideal means, and its main purpose is to improve the symptoms of atrial fibrillation patients, improve the quality of life of patients. Radiofrequency electrical energy is a kind of low-voltage high-frequency electrical energy, which is released through radiofrequency electrodes to cause specific localized cardiomyocytes to be dehydrated, denatured, and necrotic, and both autoregulation and conduction performance are altered, so as to make arrhythmia eradicated. With the growing maturity of atrial fibrillation ablation technology and the continuous improvement of related devices, it has become the first-line treatment for paroxysmal atrial fibrillation in most medical centers in Europe and the United States. Recent studies have demonstrated that catheter ablation is significantly better than antiarrhythmic drug therapy. For example, the results of the Paroxysmal Atrial Fibrillation Ablation Trial showed that the catheter ablation group had a power of 86%, compared with 22% in the drug-treated group. For chronic atrial fibrillation, the results of the study showed a 63% success rate for catheter ablation versus 17% for antiarrhythmic drugs. Currently, in experienced centers, the success rate of a single catheter ablation for paroxysmal atrial fibrillation is around 80%, and can reach 90% after two. For chronic atrial fibrillation, the success rate of one catheter ablation is about 70%, and after two, it can reach 80% to 90%. With the deepening of understanding, accumulation of experience and improvement of instruments, the safety of catheter ablation of atrial fibrillation is getting higher and higher, and at the same time, its treatment methods and means are also becoming more and more perfect, reflecting the principle of individualized and targeted treatment: (1) Segmental pulmonary vein electrical isolation: its purpose is to cause the separation of the electrical activity between the pulmonary veins and the atria, and ultimately, the potential of the pulmonary veins completely disappears, and the atria cannot be triggered to the disordered electrical activity, so that the pulmonary veins can be isolated from the source of pulmonary fibrillation. The purpose of this procedure is to cause the separation of the electrical activity between the pulmonary veins and the atria, so that the potential of the pulmonary veins completely disappears and cannot trigger the disturbed electrical activity of the atria, thus eradicating atrial fibrillation triggered by the pulmonary veins from the source. Clinical data show that this procedure is effective for paroxysmal atrial fibrillation, the success rate of single ablation is between 50% and 70%, and the cure rate of recurrent patients after 2-3 ablations is 70% to 80%, which is one of the widely used procedures in the early stage. (2) Circumferential pulmonary vein ablation and its extension is a widely used procedure at present. The method is to reconstruct the simulated three-dimensional images of pulmonary veins and atria under the guidance of the CARTO calibration system (the latest progress is described in detail in the following section), and then perform circumferential linear ablation around the mouths of each pulmonary vein, and monitor the continuity of the wire diameters by the CARTO system. (3) Complex fragmentation potential ablation: In this method, all fragmentation potentials are recorded and ablated by the CARTO system in the AF rhythm until the AF is converted to sinus rhythm. (4) Plexus ablation: The cardiac vegetative nervous system plays an important role in the development and maintenance of atrial fibrillation and is currently used as an adjunct to the above procedures. (5) Step-by-step ablation - a cure for chronic atrial fibrillation: it is a flexible integration of various ablation methods to improve the success rate of chronic atrial fibrillation ablation. Heart rate control: The preferred method of ventricular rate control in atrial fibrillation is drug therapy. The drugs used to control the ventricular rate include digitalis drugs, β-blockers, calcium antagonists, class III antiarrhythmic drugs, etc. The drugs used to control the ventricular rate include digitalis drugs, β-blockers, calcium antagonists, and class III antiarrhythmic drugs. However, ventricular rate control does not change the nature of the existence of atrial fibrillation, long-term oral antiarrhythmic drugs itself has an arrhythmogenic effect, there is no complete solution to the hazards brought about by atrial fibrillation, fundamentally can not be said to be the ideal method of atrial fibrillation treatment, but only in the absence of an ideal drug to restore and maintain sinus rhythm palliative treatment of atrial fibrillation, with the radiofrequency ablation treatment of all types of atrial fibrillation has made rapid progress in the treatment of atrial fibrillation, the control of atrial fibrillation The status of ventricular rate therapy has been greatly reduced. Third, anticoagulation therapy: 72h after the occurrence of atrial fibrillation, there may be thrombus formation in the atrium. Transesophageal echocardiography reveals thrombus in 14% of left atria. To prevent thromboembolic complications, anticoagulant drugs should be applied. Drugs: warfarin, the most commonly used. Warfarin is recommended for patients with atrial fibrillation who are over 65 years of age, especially those over 75 years of age, with prior underlying heart disease or risk factors such as a history of ischemic stroke, significant valvular heart disease, hypertension, diabetes mellitus, coronary artery disease, and heart failure as a high-risk group, but with a risk of bleeding. Aspirin: the anticoagulant effect on patients with atrial fibrillation is controversial. Heparin: Heparin can be used as a rapid anticoagulant during emergency reentry. Direct thrombin inhibitor: a new type of oral anticoagulant, rapid onset of action, rapid disappearance of the effect and no bleeding risk and other characteristics, but is still in the stage of clinical trials, is expected to become a new method of anticoagulation therapy for atrial fibrillation. Fourth, the latest progress: 1, statin lipid-lowering drugs: in recent years, the study of inflammation and the development of atrial fibrillation has a close relationship, the study shows that statins have lipid-lowering other than anti-inflammatory effect, can significantly reduce the recurrence rate of isolated atrial fibrillation after resumption of rhythm. Preliminary studies have found that statins have the effect of preventing the occurrence of atrial fibrillation, and further in-depth research is needed. 2, angiotensin-converting enzyme inhibitors and receptor blockers (antihypertensive drugs): it is currently believed that these drugs can improve the atrial electrical and structural remodeling, the primary and secondary prevention of atrial fibrillation may be beneficial, long-term application may reduce the occurrence of atrial fibrillation in patients with hypertension, ventricular hypertrophy, or heart failure (primary prevention); patients with existing atrial fibrillation after the resumption of rhythm, and the combined application of antiarrhythmic drugs can reduce the recurrence of atrial fibrillation ( Secondary prevention). 3, CARTO magnetic navigation system: is a milestone breakthrough in the field of catheter intervention. The magnetic navigation ablation catheter can easily and accurately reach the target point in the cardiac cavity under the traction of magnetic wire, which further improves the success rate of radiofrequency ablation for atrial fibrillation, and at the same time, reduces surgical complications and intra-operative X-ray irradiation time for patients and operators. In addition, the CARTO system is now able to integrate with cardiac MRI and rotational CT images in real time, making catheter ablation more intuitive, safe and effective. At the same time, the new ablation technology of cold saline infusion and the new type of specimen catheter for ablation treatment of atrial fibrillation can greatly enhance the ablation effect and shorten the operation time. In conclusion, with the application of new technological methods, the indications for catheter ablation treatment of all kinds of atrial fibrillation are widening, and it will become a routine treatment option for the eradication of atrial fibrillation.