rapid excitation of atrium resulting in dyssynchronous atrial contraction and irregular ventricle excitation.

<aside> 💡 progressive from paroxysmal (self terminating episodes <48hrs)→ persistant (>7days) → long standing (>1 year)→ permanent (removal of therapy)

</aside>

Aetiology

• 70% patients with AF have structural heart disease like congestive heart failure, ischemic heart disease, myocarditis, pericarditis, cardiomyopathy, and hypertensive heart disease. Extrinsic determinants like hyperthyroidism, diabetes mellitus, sleep apnoea and obesity are important and may be overlooked.

PIRATES

• Pulmonary disease
• Infection, IHD
• RHF/RHD
• Alcohol, anaemia
• Thyrotoxicosis
• Endocarditis, electrolytes
• Sick sinus syndrome

also: IHD, HTN, valvular heart disease, electrolytes (hypolkalemia, hypomagnesaemia), drugs (sympathomimetics), cardiomyopathy, phaechromocytoma + more

Risk Factors

• Age
• Heart Diseases and events (IHD, CHF etc)
• HTN
• surgery
• alcohol
• obesity
• family Hx

Triggers

people with paroxsysmal AF may have it triggered by

• Alcohol

• stress/anxiety

• caffeine

• Exercise

• Fatigue/ lack of sleep

• infection

• medications

• smoking

• dehydration

• Pathophysiology

Investigation findings

• 12-lead ECG (irregularly irregular QRS complexes with no clear P waves, instead showing fibrillation waves
• TFT: Thyroid stimulating hormone test for hyperthyroidism (not for acute AF)
• echocardiogram
• UEC: hypokalemia, magnaesemia

Management

Treat trigger

• DC cardioversion
• Rate control
• Rhythm control
• Anticoagulation

Complications

thromboembolism → stroke/TIA