Atrial fibrillation

Abstract

Atrial fibrillation (AF) describes the rapid, uncoordinated contraction of atrial myoctes. It is the most common arrhythmia worldwide, and is estimated to affect around 1 000 000 people in the UK. The management of AF is directed at identifying the underlying cause as well as mitigating immediate and long-term consequences of the arrhythmia, most importantly stroke and congestive cardiac failure. Young patients with ‘lone AF’ may benefit from a rhythm-control strategy using electrical or chemical cardioversion, whereas in older patients with underlying comorbidity a rate-control strategy may be more appropriate. Newer treatments such as catheter ablation may be indicated in those who remain symptomatic despite drug therapy. Most patients in the long term will benefit from oral anticoagulation in the form of warfarin or a novel oral anticoagulant for stroke thromboprophylaxis. This article will review the diagnosis, risk assessment, immediate and long-term management of this common arrhythmia.