This is the most common cardiac arrhythmia, and can be asymptomatic; it can be detected by taking the patient's pulse and noting its irregularly irregular rhythm.
- Acute: onset within the previous 48 hours (if less than 48 hours, won't increase risk of stroke during electrical cardioversion)
- New onset: AF identified for first time eg on ECG
- Paroxysmal: spontaneous termination within seven days and most often within 48 hours.
- Persistent: not self-terminating; lasting longer than seven days, or prior cardioversion.
- Permanent: Long-standing AF (> 1 year) that is not successfully terminated by cardioversion, when cardioversion is not pursued or has relapsed following termination.
- High Alcohol Intake
- High Caffeine Intake
- Heart disease (eg: rheumatic heart disease, ischaemic heart disease, WPW)
- Dehydration - electrolyte changes
- Acute infections
Signs & Symptoms
- Exercise Intolerance
- Shortness of Breath
- Irregularly Irregular pulse
- Irregularly irregular R-R intervals
- Chaotic P wave activity (often can't see P waves)
- Normal QRS complexes
Chest X-Ray & Echocardiography may also be performed to exclude other causes
- New-onset AF = cardioversion - electrically if unstable CV status or >48 hours; pharmacological if stable
- Paroxysmal AF= Rhythm control - beta blocker or other rhythm control drugs; pill in the pocket
- Persistent AF= Rate or Rhythm control (if reversible cause or heart failure caused by AF)
- Permanent AF= Rate control
- Medical cardioversion- flecanide, propafenone, amiodarone
- AV node ablation
- β-blocker (atenolol, metoprolol) or rate limiting calcium channel blocker (diltiazem, verapamil)
- If this fails, use digoxin if sedentary
Always consider anticoagulation!! - Warfarin or NOACs to prevent stroke.
CHADSVASc Score - Congestive heart failure, hypertension, age (65-74 – 1; >=75 – 2), DM, Stroke/TIA/thromboembolism (2); vascular disease, female - Offer anticoagulation if score >=2; or >=1in men
Asses risk of bleeding using HAS-BLED: Hypertension (>160mmHg uncontrolled), Abnormal renal function; liver function; Stroke, prior major Bleeding/predisposition to bleeding, Labile INR, Elderly (age>=65), Drug therapy - medication (antiplatelet agents, NSAIDS), alcohol history (>=8drinks/week)
Potential screening for atrial fibrillation in the future to pick up people earlier and prophylactically manage with anticoagulation.
- oran PS, Teljeur C, Ryan M, Smith SM. Systematic screening for the detection of atrial fibrillation. Cochrane Database of Systematic Reviews 2016, Issue 6. Art. No.: CD009586. DOI: 10.1002/14651858.CD009586.pub3.