Chronic atrial fibrillation - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Established atrial fibrillation (AF) is clinically diagnosed "paroxysmal," "persistent," "long-standing persistent," and "permanent" chaotic and irregular atrial arrhythmia.
Prevalence increases progressively with age.
Patients frequently have coexisting cardiac or noncardiac conditions, such as hypertension, coronary artery disease, valvular disease, heart failure, obesity, sleep apnea, or pulmonary disease.
Causes significant morbidity (e.g., palpitations, dyspnea, angina, dizziness or syncope, and features of heart failure, tachycardia-induced cardiomyopathy, or stroke) and death. Many patients are asymptomatic or have symptoms that are less specific for cardiac arrhythmias, such as mild dementia or silent strokes.
ECG shows absent P waves, presence of fibrillatory waves, and irregularly irregular QRS complexes.

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History & Exam
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Atrial fibrillation: P waves are not discernible; the ventricular (QRS complexes) rate is irregularly irregular
Atrial fibrillation: P waves are not discernible; "fibrillatory or f waves" of varying amplitudes and very rapid and irregular rates are particularly seen in lead V1; the ventricular (QRS complexes) rate is irregularly irregular
Atrial flutter: typical saw-tooth appearance of the flutter waves in the inferior leads (leads II, III, and aVF) indicates typical counterclockwise atrial flutter; the ventricular (QRS complexes) rate is variable
Multifocal atrial tachycardia: there are P waves of multiple (at least 3) different morphologies
Atrial tachycardia: bursts of atrial tachycardia (10 beats in the middle section of the rhythm strip II at bottom) follows sinus complexes
Sinus rhythm with premature atrial complexes
Sinus rhythm with premature ventricular complexes

Citations

Key Articles

Hindricks G, Potpara T, Dagres N, et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2021 Feb 1;42(5):373-498.[Full Text]
National Institute for Health and Care Excellence. Atrial fibrillation: diagnosis and management. Jun 2021 [internet publication].[Full Text]
Sharma M, Cornelius VR, Patel JP, et al. Efficacy and harms of direct oral anticoagulants in the elderly for stroke prevention in atrial fibrillation and secondary prevention of venous thromboembolism: systematic review and meta-analysis. Circulation. 2015 Jul 21;132(3):194-204.[Abstract][Full Text]
Lip GY, Haguenoer K, Saint-Etienne C, et al. Relationship of the SAMe-TT₂R₂ score to poor-quality anticoagulation, stroke, clinically relevant bleeding, and mortality in patients with atrial fibrillation. Chest. 2014 Sep;146(3):719-26.[Abstract]
Kuck KH, Brugada J, Furnkranz A, et al; FIRE AND ICE Investigators. Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation. N Engl J Med. 2016 Jun 9;374(23):2235-45.[Abstract][Full Text]
Luik A, Radzewtiz A, Kieser M, et al. Cryoballoon versus open irrigated radiofrequency ablation in patients with paroxysmal atrial fibrillation: the prospective, randomized, controlled, noninferiority FreezeAF Study. Circulation. 2015 Oct 6;132(14):1311-9.[Abstract][Full Text]
Del-Carpio Munoz F, Gharacholou SM, Munger TM, et al. Meta-analysis of renal function on the safety and efficacy of novel oral anticoagulants for atrial fibrillation. Am J Cardiol. 2016 Jan 1;117(1):69-75.[Abstract]

Other Online Resources

GARFIELD-AF Risk Calculator
ATRIA Stroke Risk Score
MdCalc. HEMORR₂HAGES Score for Major Bleeding Risk
SAMe-TT₂R₂ score
MdCalc: HEMORR₂HAGES Score for Major Bleeding Risk
WarfarinDosing.org
UpBeat: atrial fibrillation
AHA: atrial fibrillation (AF or AFib)

Referenced Articles

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