Atrial Fibrillation

Atrial Fibrillation


Atria contract at 400-600bpm, ventricular rate determined by AV node conduction.

It is classified as:

Paroxysmal: terminates spontaneously and lasts less than 7 days

Persistent: lasts more than 7 days and is terminated by treatment

Permanent: cannot restore sinus rhythm.


Structural or Valvular heart disease (mainly mitral stenosis)

Ischaemic heart disease/Hypertension/Congestive Heart Failure

Excessive alcohol consumption (>3drinks/day)

Pulmonary diseases (COPD/PE)

Post Cardiothoracic surgery



Irregularly, irregular pulse which can be slow, fast or normal.


Irregular fast palpitations, SOB, dizziness and decreased exercise tolerance


Bloods: FBC, TFTs

ECG: No visible P waves and irregularly irregular QRS complexes

24 Hour ECG: Holter monitor

Echo: Assess for structural abnormality


Rate or rhythm control and anticoagulation

Rate control: Beta blockers, calcium blockers, digoxin or a combination

Rhythm control: Pharmacological or electrical (DCCV)

IV amiodarone used for acute onset AF

Antithrombotic: Assess risk with CHADS2 or CHA2DS2-VASc score

Ablation: Cox-Maze Procedure


Stroke, TIA, impaired exercise capacity, heart failure and dementiaAF is associated with an increase in mortality

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