Improving identification and treatment of atrial fibrillation

Abstract

Atrial fibrillation is the most common sustained cardiac arrhythmia. One in 40 of the over 45s, 1 in 20 of the over 65s, 1 in 10 of the over 75s and 1 in 5 of the over 85s will have paroxysmal, persistent or permanent atrial fibrillation. Paroxysmal atrial fibrillation episodes self-terminate. Persistent atrial fibrillation will not stop spontaneously but sinus rhythm may be restored with treatment, and permanent atrial fibrillation occurs when all attempts to restore sinus rhythm have been abandoned. The natural history is for paroxysmal episodes to increase until they become persistent. Although many individuals will have idiopathic atrial fibrillation with otherwise healthy hearts and no comorbidities, its development is associated with a number of common risk factors. Every patient with a diagnosis of atrial fibrillation should have a physical examination to assess BP and look for signs of valve disease and heart failure. It is routine to check thyroid function and NICE recommends echocardiographic assessment. Atrial fibrillation results in the loss of normal atrial contraction as well as influencing clotting factors. This may lead to the development of left atrial thrombus. The risk of systemic thromboembolism and stroke is increased five-fold in atrial fibrillation.