Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. AF increases the risk hemodynamic impairment and thromboembolic events. It may occur paroxysmally, but it often becomes chronic. Signs of acute atrial fibrillation are: hypotension, myocardial ischemia, decreased perfusion of vital organs and acute congestive heart failure (CHF). Chronic atrial fibrillation increases the risk of atrial mural thrombus and embolus. Some conditions associated with atrial fibrillation are: mitral stenosis, lung disease, heart disease, sepsis, hyperthyroidism and cardiac surgery.
Treatment is directed at rate control, antithrombotic therapy and correction of rhythm. Slowing the ventricular rate by increasing the AV node refractory period. Digoxin, beta-adrenergic blockers, calcium channel blockers may be used to reduce the rate of AV conduction to 80-100 beats/minute. Patients with chest pain, ischemia, congestive heart failure, mitral stenosis or hypotension may require intravenous verapamil, digoxin or a combination to quickly control the ventricular rate. In appropriate patients cardioversion either chemical, electrical or a combination may be required to convert this arrhythmia to normal sinus rhythm.
The hallmark sign of atrial fibrillation is: