Key Points
Î AF is a supraventricular tachyarrhythmia with uncoordinated atrial
activation and consequently ineffective atrial contraction.
Î AF incidence increases with advancing age.
Î Rate control (principally with beta-blockers and/or non-
dihydropyridine calcium channel blockers) versus rhythm control
(cardioversion, antiarrhythmic drugs, AF ablation) strategies may be
considered in treating patients with AF.
Î Hemodynamic consequences of AF can result from a variable
combination of suboptimal ventricular rate control (either too rapid
or too slow), loss of coordinated atrial contraction, beat-to-beat
variability in ventricular filling, and sympathetic activation.
Î Consequences for individual patients vary, ranging from no symptoms
to fatigue, palpitations, dyspnea, hypotension, syncope, or HF. The
most common symptom of AF is fatigue.
Î The appearance of AF is often associated with exacerbation of
underlying heart disease, either because AF is a cause or consequence
of deterioration, or because it contributes directly to deterioration.
Î AF also confers an increased risk of stroke and/or peripheral
thromboembolism owing to the formation of atrial thrombi, usually in
the LAA.
Î Treatment strategies to reduce the risk of thromboembolism may
include anticoagulation with warfarin or newer anticoagulants, and are
guided using the CHA
2
DS
2
-VASc score.
2
