▪️Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in clinical practice.
• The prevalence was higher in men than women
• The prevalence of AF increases with age(often >65y/o)

▪️Chronic disease associations:
Hypertensive heart disease and coronary heart disease are the most common chronic disease associations in patients with AF in developed countries.
Other frequent causes include alcohol excess, heart failure, valvular heart disease including both regurgitant and stenotic lesions, and hyperthyroidism

☝️PAC is most important as a trigger in patients with
paroxysmal AF who have normal or near-normal hearts.

🔎Few statements:

☺️Caffeine: there is no evidence in
humans that ingestion of caffeine in doses typically consumed can provoke AF or any other spontaneous arrhythmia.

❗️Alcohol: is both a chronic risk factor for the development of new AF and also an acute trigger for AF episodes. (the holiday heart syndrome)

❗️Night shift work: study showed that both current and lifetime night shift exposures were associated with increased AF risk, regardless of genetic AF risk.

❗️Medications: theophylline, adenosine , and drugs that enhance vagal tone, such as digitalis.

🔎Paroxysmal atrial fibrillation (PAF; also known as intermittent AF):
• defined as AF that terminates spontaneously or with intervention within seven days of onset.

• Management: The management of the arrhythmia in patients with PAF is similar to that for the
general population of patients with AF. Important considerations are the duration of AF and the
presence or absence of symptoms during episodes.

🔎Valvular AF:
This refers to patients with moderate to severe mitral stenosis.

▪️SCREENING

▫️Uptodate:
We do not currently screen asymptomatic patients for AF.
In a general population and among persons
>65 years of age, screening has not been shown to be better than usual care (eg, pulse palpation on physical examination) for AF detection.

🔸ESC 2024:
Routine heart rhythm assessment during healthcare contact is recommended in all individuals aged ≥65 years for earlier detection of AF.

▪️Common scenarios(for new diagnosis of AF)
• routine examination(irregularly irregular pulse)
• ECG
• stroke or other arterial thromboembolism
• 24-hour ambulatory monitor
• During hospitalization
• Apple watch


▪️EVALUATION

▫️Symptoms(may or may not, often non specific):
💡Palpitations,Tachycardia, Fatigue,Weakness,Dizziness,Lightheadedness,Reduced exercise capacity,Increased urination,Mild dyspnea.
❗️Presyncope or rarely syncope

💡An apical-radial pulse deficit is commonly observed in patients in AF.

▫️ECG: For all patients with suspected new-onset AF, we obtain a 12-lead ECG.

▫️Echocardiogram: We obtain a transthoracic echocardiogram (TTE) even if the physical examination is otherwise normal.

▫️Laboratory testing:
• We obtain a complete blood count, serum electrolytes, and assessment of renal function, particularly in patients for whom a nonvitamin oral anticoagulant might be started.
• TSH and free T4 levels should be obtained in all
patients with a first episode of AF, or in those who develop an increase in AF frequency.
❗️We do not order troponin unless acute ischemia is suspected.

▪️the ventricular rate (during the day)

▫️In the typical patient with untreated AF:
90 and 170.

▫️A ventricular rate above 200 beats/min:
Catecholamine excess, Enhanced AV nodal conduction, Parasympathetic withdrawal, Hyperthyroidism, An accessory pathway as occurs in the preexcitation syndrome.

▫️less than 60 beats/min:
Increased vagal tone, Drugs that affect AV nodal conduction, AV nodal disease.