Chronic atrial fibrillation

Last reviewed: 17 Apr 2022
Last updated: 09 Jun 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • palpitations
  • tachycardia
  • irregular pulse
More key diagnostic factors

Other diagnostic factors

  • stroke
  • shortness of breath
  • fatigue
  • chest pain
  • dizziness
  • hypotension
  • elevated jugular venous pressure
  • murmur or gallop rhythm
  • rales
  • decrease in mentation or listlessness
Other diagnostic factors

Risk factors

  • hypertension
  • coronary artery disease
  • congestive heart failure
  • advancing age
  • diabetes mellitus
  • rheumatic valvular disease
  • alcohol abuse
  • male sex
  • presence of other arrhythmias
  • smoking
  • thyroid disease
  • autonomic neuronal dysfunction
  • obesity and obstructive sleep apnoea (OSA)
  • caffeine abuse
  • cancer
  • working long hours
  • excessive exercise
  • height
More risk factors

Diagnostic investigations

1st investigations to order

  • ECG
  • thyroid profile
  • echocardiogram
  • serum urea and electrolytes (including serum magnesium)
More 1st investigations to order

Investigations to consider

  • serum transaminases
  • prolonged ECG monitoring
More investigations to consider

Treatment algorithm

ACUTE

paroxysmal or persistent AF: haemodynamically unstable

paroxysmal or persistent AF: haemodynamically stable

ONGOING

permanent AF

Contributors

Authors

Arti N. Shah, MS, MD

Assistant Professor of Medicine

Mount Sinai School of Medicine

New York

NY

Disclosures

ANS declares that she has no competing interests.

Bharat K. Kantharia, MD, FRCP, FAHA, FACC, FESC, FHRS

President, Cardiovascular and Heart Rhythm Consultants

Clinical Professor of Medicine

Icahn School of Medicine at Mount Sinai

Attending and Consultant Cardiac Electrophysiologist

Mount Sinai and New York Presbyterian Hospitals

New York

NY

Disclosures

BKK declares that he has no competing interests.

Peer reviewers

Andrew R.J. Mitchell, BM, MD, FRCP, FESC, FACC

Consultant Cardiologist

Jersey General Hospital

St Helier

Jersey

Channel Islands

Disclosures

ARJM declares that he has no competing interests.

Diwakar Jain, MD, FACC, FRCP, FASNC

Professor of Medicine (Cardiology)

Westchester Medical Center

Valhalla

NY

Disclosures

DJ declares that he has no competing interests.

Konstadinos Plestis, MD, FACS

Associate Professor

Department of Cardiothoracic Surgery

Mount Sinai Medical Center

New York

NY

Disclosures

KP declares that he has no competing interests.

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