From the Guidelines
Atrial fibrillation (AFib) is a type of irregular heartbeat that requires prompt medical attention.
Definition and Pathophysiology
AFib is characterized by uncoordinated atrial activation and ineffective atrial contraction, resulting in irregular R-R intervals, absence of distinct repeating P waves, and irregular atrial activity on an electrocardiogram (ECG) 1.
Clinical Presentation and Risks
The effects of AFib are variable across individual patients, but it can lead to symptoms such as irregular palpitations, lightheadedness, malaise, and poor quality of life, as well as increased risks of stroke, heart failure, and thromboembolic disease 1.
Key Considerations
The management of AFib involves a holistic approach, incorporating stroke prevention, addressing symptoms, and risk factor management, with anticoagulation therapy being crucial to prevent stroke 1.
- Risk Factors: AFib is associated with various cardiovascular and non-cardiovascular risk factors, including hypertension, rheumatic mitral valve disease, coronary artery disease, and congestive heart failure 1.
- Treatment Approach: The treatment approach should be individualized based on the patient's symptoms, medical history, and other factors, with a focus on rate control, rhythm control, and anticoagulation therapy 1.
- Patient Empowerment: Patient empowerment is critical in the management of AFib, with education and awareness being essential for patients and healthcare professionals to achieve better outcomes and constrain the impact of AFib on patients and healthcare services 1.
From the Research
Definition and Characteristics of Atrial Fibrillation
- Atrial fibrillation (AFib) is the most common sustained cardiac rhythm disorder, characterized by a rapid and irregular heartbeat 2, 3, 4, 5, 6.
- It can be asymptomatic or lead to symptoms such as palpitations, dyspnea, fatigue, and chest pain 2, 3, 4, 5, 6.
- The condition increases in prevalence with increasing age and the number of cardiovascular comorbidities 2, 3, 4, 6.
Complications and Risks Associated with Atrial Fibrillation
- Atrial fibrillation is associated with serious complications, including an increased risk of stroke, heart failure, myocardial infarction, dementia, chronic kidney disease, and mortality 2, 3, 4, 6.
- The risk of stroke and thromboembolic events can be assessed using the CHA2DS2-VASc score 3, 4.
- Anticoagulation with a vitamin K antagonist or direct oral anticoagulant can reduce the risk of stroke by 60% to 80% compared with placebo 4.
Diagnosis and Management of Atrial Fibrillation
- Diagnosis is based on history and physical examination findings and should be confirmed with 12-lead electrocardiography or other recording device 3, 6.
- Management strategies include stroke prevention, rate control, and rhythm control 2, 3, 4, 5, 6.
- Lifestyle and risk factor modification, including weight loss and exercise, are recommended to prevent AF onset, recurrence, and complications 4.
- Early rhythm control with antiarrhythmic drugs or catheter ablation may be recommended for some patients with AF 4.