6. Atrial Fibrillation
Published Online: 1 NOV 2012
Copyright © 2013 John Wiley & Sons, Ltd.
Bennett's Cardiac Arrhythmias: Practical Notes on Interpretation and Treatment, Eighth Edition
How to Cite
Bennett, D. H. (2013) Atrial Fibrillation, in Bennett's Cardiac Arrhythmias: Practical Notes on Interpretation and Treatment, Eighth Edition, John Wiley & Sons, Ltd, Oxford. doi: 10.1002/9781118432389.ch6
- Published Online: 1 NOV 2012
- Published Print: 14 JAN 2013
Print ISBN: 9780470674932
Online ISBN: 9781118432389
- Atrial fibrillation;
- ECG characteristics;
- Rhythm management;
- Systemic embolism
Atrial fibrillation is characterised by a totally irregular ventricular rhythm and absence of P waves. It may be paroxysmal, persistent or permanent. Causes include hypertension, myocardial infarction, cardiomyopathy, valve disease, hyperthyroidism, sick sinus syndrome and alcohol. Commonly it is idiopathic. Prevalence increases with age: there is a 26% ‘lifetime’ likelihood of the arrhythmia.
Treatment has to be tailored to the individual according to the cause, clinical effects and associated risks from the arrhythmia. Though cardioversion usually restores sinus rhythm, recurrence is common. Flecainide, amiodarone and sotalol but not digoxin may terminate and/or prevent atrial fibrillation. The ventricular response to atrial fibrillation can be controlled by calcium antagonists or beta-blockers: digoxin may fail to control the rate, particularly during exercise.
Stratification of risk of embolism using the CHA2DS2VASc system guides the therapeutic options in non-valvular fibrillation: aspirin, oral anticoagulants (e.g. warfarin or dabigatran), or left atrial occlusion device.