Chronic atrial fibrillation

Chronic atrial fibrillation (AF) is a longstanding chaotic and irregular atrial arrhythmia. It is primarily defined based on duration and frequency of episodes; therefore, chronic AF could be paroxysmal, persistent, or permanent.

Prevalence increases progressively with age.

Patients frequently have co-existing cardiac or non-cardiac conditions, such as hypertension, coronary artery disease, valvular disease, heart failure, obesity, and sleep apnoea or pulmonary disease.

Causes significant morbidity (e.g., palpitations, dyspnoea, angina, dizziness or syncope, and features of heart failure, tachycardia-induced cardiomyopathy, or stroke) and death. Many patients are asymptomatic or have symptoms that are less specific for cardiac arrhythmias, such as mild dementia or silent strokes.

ECG shows absent P waves, presence of fibrillatory waves, and irregularly irregular QRS complexes.

Treatment strategy depends on the severity of symptoms, the duration of AF, and the presence of comorbid conditions. Treatment involves correction of the abnormal rate, or rate plus rhythm, along with anticoagulation in high-risk patients.

Risks and benefits of a chosen therapy, such as rate control or rhythm control strategies utilising beta-blockers, calcium blockers, digoxin, anti-arrhythmic agents, catheter-based or surgical ablation for pulmonary vein isolation and left atrial substrate modification, pacemakers, and ablation of the atrioventricular node need to be weighed based on multiple clinical factors to optimise patient outcome.

AF is a supraventricular tachyarrhythmia. It is characterised by uncoordinated atrial activity on the surface ECG, with fibrillatory waves of varying shapes, amplitudes, and timing associated with an irregularly irregular ventricular response when atrioventricular conduction is intact.[Figure caption and citation for the preceding image starts]: Atrial fibrillation: P waves are not discernible; the ventricular (QRS complexes) rate is irregularly irregularFrom the collection of Dr Arti N. Shah [Citation ends]. It is primarily defined based on duration and frequency of episodes; therefore, chronic AF could be paroxysmal, persistent, or permanent, and even new onset if detected for the first time.

For details on new-onset AF, please see New-onset atrial fibrillation.