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Atrial Fibrillation

 
 
 
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Overview

Atrial fibrillation is an often insidious condition involving irregular contraction of the ventricles due to fibrillation of the atria. If not properly managed this condition can result in significant complications including cardioembolic stroke.
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  • Diagnosis - when diagnosed, persistence
  • Management - previous DC cardioversion, rate / rhythm control, anticoagulation
  • Complications - past stroke, heart failure
  • Classification

  • Paroxysmal AF - occurring for <7 days
  • Persistent AF - occurring for >7 days
  • Permanent AF - long-standing despite attempts at cardioversion
  • Causes of Atrial Fibrillation

  • Severe acute illness - especially in septic or postoperative patients
  • Cardiac - post cardiac surgery, myocardial infarction, valvular disease, cardiomyopathy, congestive cardiac failure, congenital heart disease, Wolff-Parkinson-White
  • Cardiovascular risk factors - hypertension, diabetes, obesity
  • Pulmonary embolism
  • Obstructive sleep apnoea
  • Thyrotoxicosis
  • Alcohol abuse

Complications

  • Complications of Atrial Fibrillation

  • Thromboembolic stroke
  • Heart failure
  • Syncope

Management

  • Management Options

  • Rate control - beta blockers, calcium channel blockers, digoxin
  • Rhythm control - DC cardioversion, flecainide, sotalol, amiodarone
  • Catheter ablation - of the pulmonary vein orifices
  • Anticoagulation (to prevent stroke) - warfarin, dabigatran, rivaroxaban, apixaban
Stroke prevention is a major priority in the management of atrial fibrillation, though anticoagulation is not without risks. Clinical calculators such as CHAâ‚‚DSâ‚‚VASc are used to estimate risk of stroke and assist in deciding whether anticoagulation is necessary.
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