Overview
Atrial fibrillation is a supraventricular arrhythmia characterized by disorganized atrial electrical activity and ineffective atrial contraction.
The ventricular response may be rapid, slow, or relatively controlled depending on conduction through the atrioventricular node and the patient's treatment.
Clinical Features
Patients may experience palpitations, dyspnea, fatigue, reduced exercise tolerance, dizziness, or chest discomfort.
Some patients are asymptomatic and are diagnosed incidentally.
An irregularly irregular pulse should immediately raise suspicion for atrial fibrillation.
ECG Findings
ECG typically demonstrates an irregularly irregular ventricular rhythm with absent organized P waves and variable baseline atrial activity.
Complications
The most important complication is thromboembolism, particularly ischemic stroke, due to blood stasis within the atria.
Persistent rapid ventricular rates may also contribute to tachycardia-mediated ventricular dysfunction.
Management therefore addresses both symptoms/rate or rhythm and the patient's risk of thromboembolism.
Management
Management is individualized according to symptom burden, haemodynamic status, duration of arrhythmia, underlying heart disease, and thromboembolic risk.
Strategies may involve ventricular rate control, rhythm control, anticoagulation when indicated, and treatment of underlying precipitants or cardiovascular disease.
Clinical Pearls
In atrial fibrillation always think about two separate problems: the rhythm itself and the risk of thromboembolism.
END OF REVIEW
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