Atrial fibrillation

A. Presentation

Palpitation (rapid irregular rhythm)

Weakness, faint, breathlessness

May present with signs and symptoms of systemic embolism

 

B. Investigation

ECG

 

Rule out other causes

• Thyrotoxicosis ---> thyroid function test
• Alcohol toxicity
• Chest infection

C. Treatment

Anticoagulation therapy

Use heparin (short term) or warfarin (for long term)

When using warfarin, target INR range = 2~3

 

If the patient has sustained non-valvular AF but without any of the following risk factors

• Previous thromboembolism
• Hypertension
• Heart failure
• Female >75

     ---> Use aspirin instead of warfarin/heparin (reduced benefit but much reduced risk of side effect)

 

Conversion therapy

Anticoagulation therapy with heparin or warfarin should start before elective cardioversion (unless AF is <24 hours in duration)

 

Pharmacological cardioversion

Sotalol (?III, also a beta-blocker) OR

Fecainide (Ic) OR

Amiodarone (III)

 

If drug conversion fails, try synchronized electrical cardioversion.

 

D. Other notes

[epidemilogy/risk factors/
causes/mechanisms/compications/ddx/
classification/staging/
followups/prognosis/prognostic factors/prevention]