Summary

• Chaotic and irregular atrial arrhythmia, the prevalence of which increases progressively with age and affects almost 5% of the population older than 69 years of age.
• Causes significant morbidity and mortality including palpitations, dyspnoea, angina, dizziness or syncope, and features of congestive heart failure (CHF), tachycardia-induced cardiomyopathy, stroke, and death.
• ECG shows absent P waves, presence of fibrillatory waves, and irregularly irregular QRS complexes.
• Most patients presenting with acute atrial fibrillation (AF) do not require immediate intervention. Most patients will require medical therapy to control ventricular rate.
• Patients who develop haemodynamic compromise should have immediate direct current cardioversion.
• If the precise timing of the onset of AF is unclear, a transoesophageal echocardiogram must be performed to exclude left atrial clots before cardioversion.