Atrial fibrillation

Overview

Atrial fibrillation is the most prevalent cardiac arrhythmia and carries substantial morbidity, mortality and economic burden. Its incidence and prevalence rise steeply with age, which makes general practice — where multimorbidity concentrates — the main arena of AF care. The 2023 ACC/AHA/ACCP/HRS guideline calls it the most sustained common arrhythmia.^[23][22]

The disease kills through three routes: stroke (the most feared), tachycardia-induced cardiomyopathy, and symptom-driven deterioration. All three are preventable with systematic application of four levers — detection, anticoagulation, rate/rhythm control and risk-factor treatment. The 2024 ESC guidelines compress these into the AF-CARE pathway.^[24][23]

AFFIRM set the twentieth-century default — rate control equals rhythm control — but EAST-AFNET 4 showed that early rhythm control within a year of diagnosis lowers cardiovascular death, stroke and heart-failure hospitalisation by roughly a fifth. The modern question is no longer whether to pursue sinus rhythm, but how early and by what means.^[1][15]

References24ShowHide

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