Cardiovascular - Atrial Fibrillation

In this episode, we review atrial fibrillation (AF), the most common sustained cardiac arrhythmia, and discuss the underlying mechanisms driving its characteristic "irregularly irregular" rhythm. We cover the pathophysiology of chaotic atrial electrical activity, major risk factors including advanced age, hypertension, obesity, heart failure, and sleep apnea, and the growing prevalence of AF in the aging population. Clinically, patients may present with palpitations, fatigue, dyspnea, dizziness, chest pain, or exercise intolerance, while some remain asymptomatic. We break down the diagnostic approach with emphasis on classic EKG findings including absent P waves, fibrillatory baseline activity, and variable R-R intervals. Management focuses on the modern AF-CARE approach, including stroke prevention with anticoagulation, rate and rhythm control strategies, and aggressive risk factor modification. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817 Bizhanov KA, Аbzaliyev KB, Baimbetov AK, Sarsenbayeva AB, Lyan E. Atrial fibrillation: Epidemiology, pathophysiology, and clinical complications (literature review). Journal of Cardiovascular Electrophysiology. 2022;34(1):153-165. doi:https://doi.org/10.1111/jce.15759 Gawałko M, Linz D. Atrial fibrillation detection and management in hypertension. Hypertension. 2023;80(3):523-533. doi:10.1161/hypertensionaha.122.19459 Van Gelder IC, Rienstra M, Bunting KV, et al. 2024 ESC guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (eacts). European Heart Journal. 2024;45(36):3314-3414. doi:10.1093/eurheartj/ehae176