Home Forums Other Specialities Cardiothoracic Medicine & Surgery ATRIAL FIBRILLATION- A CHAPTER.

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    Atrial fibrillation – Summary

    Atrial fibrillation (AF) is an arrhythmia. It results from irregular, disorganized electrical activity in the atria, leading to an irregular ventricular rhythm. The ventricular rate of untreated AF often averages between 160–180 beats per minute (although this is typically slower in elderly people).

    The most common causes of AF are ischaemic heart disease, hypertension, valvular heart disease, and hyperthyroidism.

    Complications of AF include:

    Stroke and thromboembolism.

    Heart failure.

    Tachycardia-induced cardiomyopathy and critical cardiac ischaemia.

    Reduced quality of life.

    AF should be suspected in people with an irregular pulse. If AF is present, an ECG will show no P-waves, a chaotic baseline, and an irregular ventricular rate.

    Management of AF includes:

    Admitting people who have severe symptoms or a serious complication.

    Identifying and managing any underlying causes.

    Treating the arrhythmia:
    a rate-control treatment (beta-blocker, rate-limiting calcium channel blocker, or digoxin) is recommended for most people with AF.

    Referral for rhythm-control treatment (cardioversion), in addition to rate-control treatment,
    – may be appropriate if the person has AF with a reversible cause (for example a chest infection); heart failure thought to be primarily caused, or worsened, by AF; or new-onset AF.

    Assessing stroke risk using the CHA2DS2VASc assessment tool.

    Assessing the risks and benefits of anticoagulation and starting treatment if appropriate.
    The HAS-BLED assessment tool should be used to assess the risk of a major bleed and to identify and manage modifiable risk factors for bleeding, such as uncontrolled hypertension, harmful alcohol consumption, and concurrent use of aspirin or a nonsteroidal anti-inflammatory drug.

    Arranging follow up to assess compliance with treatment, efficacy of treatment, and tolerability.

    Providing advice and information on AF, its treatment, and where to find support groups.

    Referral to a cardiologist should be made if:

    Rhythm control is appropriate (see above).

    Rate-control or anticoagulant treatment is contraindicated.

    Rate-control treatment fails to control the symptoms of AF (prompt referral within 4 weeks is required).

    The person is found to have valve disease or left ventricular systolic dysfunction on echocardiography.

    Wolff–Parkinson–White syndrome or a prolonged QT interval is suspected on the electrocardiogram.

    More soon.

    G Mohan.

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