Atrial fibrillation - Revision history

Aidan at 19:19, 12 October 2025

2025-10-12T19:19:02Z

← Older revision		Revision as of 19:19, 12 October 2025
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	== ~~Definition~~ ==		== Background ==

	* A dysorganized and rapid atrial electrical activity leading to a loss of coordinated contraction of the atria and an irregularly irregular ventricular rhythm		* A dysorganized and rapid atrial electrical activity leading to a loss of coordinated contraction of the atria and an irregularly irregular ventricular rhythm
	* May be '''paroxysmal''' or '''persistent'''		* May be '''paroxysmal''' or '''persistent'''

	== ~~Etiology~~ ==		=== Etiologies ===

	* Cardiac		* Cardiac
	** Hypertension		** Hypertension
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	* Idiopathic		* Idiopathic

	== Acute Triggers ==		=== Acute Triggers ===

	* Cardiac surgery or transplant		* Cardiac surgery or transplant
	* Acute alcohol intoxication		* Acute alcohol intoxication
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	* Hyperthyroidism		* Hyperthyroidism

	== ~~Pathophysiology~~ ==		=== Epidemiology ===

	== Differential Diagnosis ==

	== Epidemiology ==

	* Prevalence by age 80 is approximately 10%		* Prevalence by age 80 is approximately 10%
	* Lifetime risk of developing AF for individuals 40 years old is approximately 25%		* Lifetime risk of developing AF for individuals 40 years old is approximately 25%

	== Risk Factors ==		=== Risk Factors ===

	* Age		* Age
	* Hypertension		* Hypertension
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	** Irregularly irregular heart rhythm		** Irregularly irregular heart rhythm
	** Variable S1		** Variable S1

		⚫	=== Prognosis ===
		⚫	* Risk of stroke by fivefold and is estimated to be the cause of 25% of strokes

	== Investigations ==		== Investigations ==
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	** Amiodarone is last-line		** Amiodarone is last-line
	* Stroke prophylaxis		* Stroke prophylaxis
	** ASA if low risk (CHADS2=0 or CHA2DS2-VASc<2)		** [[ASA]] if low risk ([[CHADS2\|CHADS<sub>2</sub>]]=0 or [[CHA2DS2-VASc\|CHA<sub>2</sub>DS<sub>2</sub>-VASc]]<2)
	** Warfarin, targeting an INR or 2-3		** [[Warfarin]], targeting an INR or 2-3
	** Direct oral anticoagulants		** Direct oral anticoagulants such as [[apixaban]] or [[rivaroxaban]]

⚫	== Prognosis ==

⚫	* Risk of stroke by fivefold and is estimated to be the cause of 25% of strokes

	== Further Reading ==		== Further Reading ==

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-14T23:24:58Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 23:24, 14 July 2020
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	* Sleep apnea		* Sleep apnea

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==

	* Feeling of palpitations, acute or paroxysmal		* Feeling of palpitations, acute or paroxysmal

Maintenance script: Imported from text file

2020-07-04T01:17:24Z

Imported from text file

New page

== Definition ==

* A dysorganized and rapid atrial electrical activity leading to a loss of coordinated contraction of the atria and an irregularly irregular ventricular rhythm
* May be '''paroxysmal''' or '''persistent'''

== Etiology ==

* Cardiac
** Hypertension
** Heart failure
** CAD
** Hypertrophic, dilated and restrictive cardiomyopathies
** '''Valvular heart disease'''
** Congenital heart disease
** Pericardial disease
** Post-surgical (particularly cardiac surgery)
** Sick sinus syndrome
** Atrial fibrillation as a result of ventricular pacing
** Supraventricular tachycardia
*** Wolf-Parkinson White syndrome
*** Atrial tachycardia
*** Atrial flutter
** Genetic/Familial
* Non-cardiac
** '''Obstructive sleep apnea'''
** Obesity
** Excessive '''alcohol''' ingestion (acute or chronic)
** '''Hyperthyroidism'''
** Vagally-mediated (i.e. habitual aerobic training)
** Pulmonary disease
*** Pneumonia
*** COPD
*** Pulmonary embolism
*** Pulmonary hypertension
* Idiopathic

== Acute Triggers ==

* Cardiac surgery or transplant
* Acute alcohol intoxication
* Acute illness including '''infection''', '''myocardial infarction''', or '''pulmonary embolism'''
* Hyperthyroidism

== Pathophysiology ==

== Differential Diagnosis ==

== Epidemiology ==

* Prevalence by age 80 is approximately 10%
* Lifetime risk of developing AF for individuals 40 years old is approximately 25%

== Risk Factors ==

* Age
* Hypertension
* Diabetes mellitus
* Cardiac disease
* Sleep apnea

== Clinical Presentation ==

* Feeling of palpitations, acute or paroxysmal
* Syncope
* Examination
** Irregularly irregular heart rhythm
** Variable S1

== Investigations ==

* Baseline: ECG, echo, CBC, coags, renal and liver function, TSH, lipids, and glucose
* Imaging
** CXR: to exclude lung disease and heart failure
** TEE: to rule out thrombus if planning cardioversion
* Labs
** Serum calcium and magnesium
** TSH
* Other
** Holter monitor or loop monitor: to capture paroxysmal atrial fibrillation when it is suspected
** Treadmill exercise test
** Electrophysiologic studies
** Sleep study: to rule out OSA
** Ambulatory blood pressure monitor
** Genetic testing

== Management ==

* Cardioversion
** May cardiovert if onset within 12h or if anticoagulated for at least 3 weeks prior (and 4 weeks after cardioversion)
** Can consider cardioversion up to 48 hours if low-risk CHADS <2
* Rate control
** If atrial fibrillation with rapid ventricular response, may need rate control to target resting HR < 100
** Beta-blockers are first-line
*** Metoprolol, starting at 25mg bid and titrating to effect
** Non-DHP CCBs are second-line
** Digoxin may be used in patients who are sedentary or have LV dysfunction
** Amiodarone is last-line
* Stroke prophylaxis
** ASA if low risk (CHADS2=0 or CHA2DS2-VASc<2)
** Warfarin, targeting an INR or 2-3
** Direct oral anticoagulants

== Prognosis ==

* Risk of stroke by fivefold and is estimated to be the cause of 25% of strokes

== Further Reading ==

* [https://doi.org/10.1016/j.cjca.2016.07.591 Atrial fibrillation guidelines focussed update 2016]

[[Category:Cardiology]]