Abstract
February 2008
Section 1 Cardiovascular Medicine
IV Atrial FibrillationAtrial fibrillation (AF) is a supraventricular tachyarrhythmia defined by rapid, irregular atrial activation. On an electrocardiogram, AF is characterized by the absence of visible discrete P waves, the presence of irregular fibrillatory waves, or both, and an irregularly irregular ventricular response. AF is the most common sustained arrhythmia, affecting more than 2 million persons in the United States. The incidence is approximately 0.1% per year for the entire population; however, the incidence of AF increases steadily with age. As a result, one out of 11 Americans older than 80 years has AF. The American College of Cardiology (ACC), the American Heart Association (AHA) and the European Society of Cardiology (ESC), in collaboration with the North American Society of Pacing and Electrophysiology, have established guidelines for the classification of AF. This chapter discusses the pathophysiology, clinical manifestations, diagnosis, and treatment of AF. Algorithms show the steps in the evaluation and management of AF. A table outlines the ACC/AHA/ESC standard recommendations for clinical evaluation of AF. Additional tests that may be indicated in specific situations are event and Holter monitoring, exercise testing, transesophageal echocardiography (TEE), and electrophysiologic study (EPS). Treatment of AF focuses on restoration and maintenance of sinus rhythm, or control of ventricular rate. Sinus rhythm can be restored with medication, electrical shocks, or a combination of both. Medications that can be used for cardioversion or for maintenance of sinus rhythm are presented in tables. AF (including paroxysmal, permanent, and chronic forms) is associated with an increased risk of strokes and other embolic phenomena. Tables and figures describe the selection of antithrombotic treatment for patients with AF. This chapter contains 101 references.
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