CHAPTER 29 Atrial Fibrillation
Atrial fibrillation (AF) is such a common arrhythmia that it is often wrongly regarded as an acceptable alternative to normal sinus rhythm. Its first onset may present with rapid and uncomfortable palpitations, breathlessness, dyspnoea, chest pain, and anxiety. Often it is entirely asymptomatic and discovered quite by chance. Paroxysmal and persistent recurrences may eventually lapse into permanent AF.The causes of AF are legion and should be identified since many can be corrected and the management of the arrhythmia can be simplified. The consequences of AF may be dire: heart failure, stroke, sudden death, markedly reduced exercise capacity, and degraded quality of life. Appropriate thromboprophylaxis, adequate rate control, and sucessful rhythm control in suitable patients are essential.
Stroke risk can be diminished by appropriate thromboprophylaxis with aspirin or vitamin K antagonists as indicated by systematic risk stratification; heart failure can be improved by competent management of underlying comorbid disease and proper rate control. Rhythm control with antiarrhythmic drugs, including beta-blockers, and left atrial ablation techniques may be needed to ameliorate symptoms and alleviate anxiety.
Chapter 28)
