Summary
Definition
Atrial fibrillation (AF) is a supraventricular tachyarrhythmia. It is characterized 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 (AV) 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 irregular
From the collection of Dr Arti N. Shah
[Citation ends].
History and exam
Key diagnostic factors
- presence of valvular heart disease, coronary artery disease, hypertension, pericarditis, cardiomyopathy, and other arrhythmias
- presence of diabetes mellitus, thyroid disease, alcohol abuse, and cancer
- palpitations
- tachycardia
- irregular pulse
Other diagnostic factors
- stroke
- shortness of breath
- fatigue
- chest pain
- dizziness
- asymptomatic
- hypotension
- elevated JVP
- murmur or gallop rhythm
- rales
- decrease in mentation or listlessness
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 apnea (OSA)
- caffeine abuse
- cancer
Diagnostic investigations
1st investigations to order
- 12-lead ECG
- thyroid profile
- echocardiogram
- serum electrolytes (including serum magnesium) and BUN
Treatment algorithm
Contributors
Authors VIEW ALL
Assistant Professor of Medicine
Mount Sinai School of Medicine
New York
NY
Disclosures
ANS declares that she has no competing interests.
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 VIEW ALL
Consultant Cardiologist
Jersey General Hospital
St Helier
Jersey
Channel Islands
Disclosures
ARJM declares that he has no competing interests.
Professor of Medicine (Cardiology)
Westchester Medical Center
Valhalla
NY
Disclosures
DJ declares that he has no competing interests.
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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