Atrial Fibrillation, Diagnosis and Initial Treatment

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    Atrial Fibrillation Diagnosis and Initial Treatment

    Basic Information


    • Atrial fibrillation is a supraventricular tachyarrhythmia characterized by chaotic, disorganized electrical activation and inefficient atrial contraction


    • Atrial fibrillation is the most common sustained cardiac arrhythmia, with a worldwide prevalence of more than 37 million (0.5% of the global population)(1)

    • Incidence and prevalence have risen steadily over the past 20 years, and they are projected to continue to rise(1)

    Etiology and Risk factors


    • Atrial fibrillation episodes are initiated by premature atrial complexes

      • Typically originate in the pulmonary veins (called pulmonary vein triggers)

      • May also come from the other structures (called non–pulmonary vein triggers2), including: • Right atrium • Superior vena cava • Posterior wall of left atrium • Vein of Marshall • Left atrial appendage

    Risk Factors

    • Risk factors for atrial fibrillation

      • Cardiac factors

      • Hypertension

      • Coronary artery disease

      • Heart failure

      • Hypertrophic cardiomyopathy

    • Extracardiac factors

      • Obesity

      • Metabolic syndrome

      • Sleep apnea

      • Diabetes mellitus

      • Excessive alcohol consumption

      • Hyperthyroidism

    • Genetic factors

      • Sometimes familial

        • Patterns of autosomal dominant inheritance have been described in some families3

        • Numerous genetic mutations have been linked to atrial fibrillation, including:

          • Ion channel mutations (sodium and potassium channels)

          • Non–ion channel mutations (eg, lamin, connexin, ryanodine receptor, cardiac transcription factors)3 European ancestry is a risk factor4

    • Advancing age


    Approach to Diagnosis

    • Presence is suggested by findings on physical examination and confirmed by ECG

    Staging or Classification

    • Classified according to predominant duration of episodes

      • Paroxysmal (terminating spontaneously or by intervention in less than 7 days)

      • Persistent (more than 7 days, often requiring direct-current cardioversion)

      • Long-standing persistent (continuous atrial fibrillation for 1 year or longer)

      • Permanent (accepted as long-term by the patient and physician, with no plans to pursue rhythm control)

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