Atrial fibrillation is the most common arrhythmia. General approach in Fig. 30.1. Who gets rhythm control approach? (Table 30.2) choice of rate control meds (Table 30.1). Calculate CVA risk by CHADS2 (Table 30.4), CHA2D2-VSc (Table 30.5), or HATCH score (Table 30.6). Bleeding risk by ORBIT (Table 30.8). HASBLED is not as useful since we don’t have ‘labile INRs’ in the era of DOAC. In ESRD patient, be careful to put patients on anticoagulation since bleeding risk is high and there is no RCTs (Table 30.9).