This is a common arrhythmia, occurring in 5-10% of patients over 65 years of age. It also occurs, particularly in a paroxysmal form, in younger patients. Any condition resulting in raised atrial pressure, increased atrial muscle mass, atrial fibrosis, or inflammation and infiltration of the atrium, may cause atrial fibrillation. There are also many systemic causes of atrial fibrillation.
Hypertension and heart failure are most often associated with non-rheumatic atrial fibrillation. Hyperthyroidism may provoke atrial fibrillation, sometimes as virtually the only feature of the disease, and thyroid function tests are mandatory in any patient with unaccounted atrial fibrillation. Atrial fibrillation occurs in one-third of patients after coronary bypass surgery and inmore than half of those undergoing valvular surgery. It usually manifests during the first 4 days and is associated with increased morbidity and mortality, largely due to stroke and circulatory failure, …show more content…
In some patients (about 30%) it is an incidental finding, whilst others attend hospital as an emergency following the onset of atrial fibrillation. Most patients experience some deterioration of exercise capacity or well-being, but this may only be appreciated once sinus rhythm is restored. When caused by rheumatic mitral stenosis, the onset of atrial fibrillation results in considerable worsening of cardiac failure. The patient has a very irregular pulse, as opposed to a basically regular pulse with an occasional irregularity (e.g. extrasystoles) or recurring irregular patterns (e.g. Wenckebach block). The irregular nature of the pulse in atrial fibrillation is maintained during exercise. The ECG shows fine oscillations of the baseline (socalled fibrillation or f waves) and no clear P waves. The QRS rhythm is rapid and irregular. Untreated, the ventricular rate is usually 120-180 per minute, but it slows with