Atrial fibrillation

Question 1

What is AF?

Answer 1

Atrial fibrillation (AF) is a supraventricular tachyarrhythmia. It is characterised by uncoordinated atrial activity on the surface ECG, with fibrillatory waves of varying shapes, amplitudes, and timing associated with an irregularly irregular ventricular response when atrioventricular conduction is intact.

Question 2

What are causes of AF?

Answer 2

• Pre-existing cardiac disease
		○ Heart failure
		○ Hypertension
		○ Mitral valve disease
		○ IHD
	• PE
	• Hyperthyroidism 
	• Caffeine and alcohol 
Electrolyte abnormalities

Question 3

What are the 3 types of AF?

Answer 3

• Paroxysmal (intermittent, starting & stopping). Terminated in < 7 days but may recur
  
  • Persistent (requiring intervention to terminate the arrhythmia, e.g. IV antiarrhythmic drug injection or DC cardioversion). Lasts > 7 days,
  • Permanent (sinus rhythm not achievable)

Question 4

What is the presentation of AF?

Answer 4

Often asymptomatic.

• irregularly irregular pulse
• palpitations, faint, dyspnoea
• stroke

Question 5

What are key investigations for AF?

Answer 5

ECG: no p waves
Bloods: TFTs, FBC, U+Es
CXR

Question 6

What is the treatment of AF?

Answer 6

1. Paroxysmal: BB or flecainide, amiodarone if cardiac disease

Permanent: control rate e.g. BB or calcium channel blocker. Consider catheter ablation

IN acute AF (<48 hours) immediate medical or electrical cardioversion. If >48 hours, then full anticoagulation and rate control for later cardioversion.

Question 7

What scoring systems should you use in AF patients?

Answer 7

CHADVASC: risk of stroke and evaluate for antiocoagulation.

HASBLED: risk of bleeding.