Atrial Fibrillation (AF)

Pathology:                    

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

It is classified as

Paroxysmal:

terminatesspontaneously and lasts less than 7 days

Persistent:

lastsmore than 7 days and is terminated by treatment

Permanent:

cannotrestore sinus rhythm

Aetiology:                    

Structural or Valvular heartdisease (mainly mitral stenosis)

Ischaemic heart disease/Hypertension/Congestive HeartFailure

Excessive alcohol consumption(>3drinks/day)

Pulmonary diseases (COPD/PE)

Post Cardiothoracic surgery

Hyperthyroidism

Symptoms:                  

Irregular fast palpitations,SOB, dizziness and decreased exercise tolerance

Signs:                              

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

Investigations:          

Bloods: FBC, TFTs

ECG: Novisible P waves and irregularly irregular QRS complexes

24 Hour ECG: Holtermonitor

Echo: Assessfor structural abnormality

Treatment:                  

‍Rate or rhythm control and anticoagulation

Rate control:

Betablockers, calcium blockers, digoxin or a combination

Rhythm control: Pharmacological orelectrical (DCCV)

IV amiodarone used for acute onset AF

Antithrombotic: Assessrisk with CHADS₂ or CHA₂DS₂-VASc score

Ablation:

Cox-MazeProcedure

Complications:          

Stroke, TIA, impaired exercisecapacity, heart failure and dementia

Prognosis:                    

AF is associated with anincrease in mortality

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