Phys · cardiovascular
Atrial Fibrillation
Also known as AF · AFib · atrial fibrillation and flutter · paroxysmal AF · persistent AF · permanent AF · lone AF · valvular AF · non-valvular AF · rapid ventricular response · RVR
Consultant-physician-depth guide to atrial fibrillation — pathophysiology, classification, rate versus rhythm control, anticoagulation with CHA₂DS₂-VASc and DOACs, catheter ablation, and rapid ventricular response management — structured for FRACP DWE and DCE preparation.
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Target exams
Red flags
- AF with haemodynamic instability requiring urgent electrical cardioversion
- AF with rapid ventricular response causing acute heart failure or ischaemia
- Pre-excited AF (Wolff-Parkinson-White) — AV nodal blockers contraindicated
- New AF after recent stroke or TIA — anticoagulation timing is critical
- AF in suspected thyrotoxicosis — treat the underlying cause
Atrial Fibrillation
Meet the patient
A 68-year-old woman with hypertension and type 2 diabetes is referred for palpitations that come and go. A Holter catches bursts of atrial fibrillation that self-terminate within hours. Her CHA₂DS₂-VASc is 4 (one point each for age 65–74, hypertension, diabetes, and female sex). The registrar wonders whether AF that "stops on its own" still needs anticoagulation.[1]
It does — and that single point is the highest-yield discriminator in the whole topic. Stroke risk follows the score, not the pattern, and paroxysmal AF carries the same risk as persistent AF at a given CHA₂DS₂-VASc.[1]
References5ShowHide
- [1]Wyse DG, Waldo AL, DiMarco JP, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation N Engl J Med, 2002.PMID 12466506
- [2]Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation N Engl J Med, 2009.PMID 19717844
- [3]Granger CB, Alexander JH, McMurray JJV, et al. Apixaban versus warfarin in patients with atrial fibrillation N Engl J Med, 2011.PMID 21870978
- [4]Kirchhof P, Camm AJ, Goette A, et al. Early Rhythm-Control Therapy in Patients with Atrial Fibrillation N Engl J Med, 2020.PMID 32865375
- [5]Packer DL, Piccini JP, Monahan KG, et al. Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial JAMA, 2019.PMID 30874766