• Refer all people with paroxysmal atrial fibrillation (AF) to a cardiologist for management.
• While the person is waiting to see a specialist:
• Start either aspirin or warfarin (if they are not contraindicated), to reduce the person's risk of stroke.
• The choice of antithrombotic treatment should be based on the person's risk of stroke and not on the frequency or duration of paroxysms of AF.
• For further information, see Which antithrombotic treatment.
• If the person is having frequent, symptomatic paroxysms but does not require admission, consider starting a beta-blocker (unless this is contraindicated).
• Seek advice if uncertain whether to start drug treatment.
• For further information, see the prescribing section on beta-blockers.
• If a specialist initiates rhythm-control treatment, initial follow up and drug monitoring will be carried out by the specialist. However, primary healthcare professionals will be involved in the longer-term follow up (for example, monitoring of drugs and identifying complications of AF).

In depth

• Advise the person that it is their responsibility to inform the Driver and Vehicle Licensing Agency (DVLA) of any condition that may affect their ability to drive.
• The DVLA's medical rules regarding atrial fibrillation are:
• For group 1 entitlement (cars, motorcycles):
• Driving must cease if the arrhythmia has caused or is likely to cause incapacity.
• Driving may be permitted when the underlying cause has been identified and controlled for at least 4 weeks
• The DVLA need not be notified unless there are distracting or disabling symptoms.
• For group 2 entitlement (lorries, buses):
• Disqualified from driving if the arrhythmia has caused or is likely to cause incapacity.
• Driving may be permitted when the arrhythmia is controlled for at least 3 months; the left ventricular ejection fraction is equal to or greater than 0.4; there is no other disqualifying condition.
• The person should check with their insurer that they are still covered for driving.
• The latest information from the DVLA regarding medical fitness to drive can be obtained at www.dvla.gov.uk/medical/ataglance.

In depth

In depth

• Advise the person that it is their responsibility to inform the Driver and Vehicle Licensing Agency (DVLA) of any condition that may affect their ability to drive.
• The DVLA's medical rules regarding atrial fibrillation are:
• For group 1 entitlement (cars, motorcycles):
• Driving must cease if the arrhythmia has caused or is likely to cause incapacity.
• Driving may be permitted when the underlying cause has been identified and controlled for at least 4 weeks
• The DVLA need not be notified unless there are distracting or disabling symptoms.
• For group 2 entitlement (lorries, buses):
• Disqualified from driving if the arrhythmia has caused or is likely to cause incapacity.
• Driving may be permitted when the arrhythmia is controlled for at least 3 months; the left ventricular ejection fraction is equal to or greater than 0.4; there is no other disqualifying condition.
• The person should check with their insurer that they are still covered for driving.
• The latest information from the DVLA regarding medical fitness to drive can be obtained at www.dvla.gov.uk/medical/ataglance.

In depth

In depth