GPAtlas🧭 When to suspect
Atrial fibrillation (AF) is the commonest sustained arrhythmia. Suspect it whenever you find an irregularly irregular pulse, or in anyone with palpitations, breathlessness, dizziness, chest discomfort or fatigue. Many people are asymptomatic: AF is often found incidentally – for example when checking the pulse before a blood pressure reading – or only after a complication such as stroke/TIA or heart failure.
Diagnosis is electrical, not clinical. An irregular pulse is the trigger to record a 12-lead ECG, which shows absent P waves and an irregularly irregular QRS. A single normal ECG does not exclude paroxysmal AF – if symptoms are intermittent, arrange ambulatory monitoring. Atrial flutter is assessed and anticoagulated along the same lines as AF.
The three primary-care tasks are best remembered as the ABC pathway: Anticoagulation to avoid stroke (the priority), Better symptom control (usually rate control), and Comorbidity and cardiovascular-risk management.
| Pattern | Definition |
|---|---|
| Paroxysmal | Self-terminating, usually within 48 hours and by definition within 7 days |
| Persistent | Continuous for > 7 days, or requires cardioversion to terminate |
| Long-standing persistent | Continuous for > 12 months when a rhythm-control strategy is still being pursued |
| Permanent | AF accepted; no further attempts to restore sinus rhythm |
Stroke risk is the same whatever the pattern – asymptomatic and paroxysmal AF are not low-risk AF, and the anticoagulation rules apply equally.
Source: NICE NG196
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.