Supraventricular tachyarrhythmia with uncoordinated atrial activation and irregular ventricular response.
Causes
- • HTN, HF, valvular disease
- • Thyroid disease, alcohol
- • Sepsis, PE, post-op
- • Lone AF
Clinical features
- • Palpitations, dyspnoea, chest pain, dizziness
- • Asymptomatic in 30%
Investigations
- • 12-lead ECG
- • TSH, U&E, TFT, LFT
- • Echo (structural)
- • Ambulatory monitoring if paroxysmal
Management
- • Rate control: β-blocker/CCB (target HR <110 lenient, <80 strict)
- • Rhythm control if symptomatic: DC cardioversion / flecainide (structurally normal) / amiodarone / ablation
- • Anticoagulation per CHA2DS2-VASc (≥2 M / ≥3 F)
Drug therapy
- • DOAC first-line (apixaban preferred in elderly/CKD)
- • LAA closure if OAC contraindicated
- • AAD: flecainide, sotalol, amiodarone
Complications
- • Stroke (5× ↑ risk)
- • HF, tachy-cardiomyopathy
- • Cognitive decline
Clinical pearls
- • ABC pathway: Anticoag, Better symptom control, Cardiovascular risk mgmt
- • Early rhythm control in HF (EAST-AFNET 4)
References
- • ESC 2020 AF Guidelines
- • AHA/ACC 2023 AF
Related in WardRound
ECG: Atrial Fibrillation
ECG · Arrhythmia
Amiodarone
Drug · Emergency Drugs
Apixaban
Drug · Anticoagulants
Aspirin (cardio dose)
Drug · Cardiology
Apixaban
Drug · Anticoagulants
Amiodarone (oral)
Drug · Cardiology
Flecainide
Drug · Cardiology
Sotalol
Drug · Cardiology
Glucagon (β-blocker/CCB overdose)
Drug · Emergency Drugs
Educational — verify locally.
