Atrial Fibrillation: A Common Arrhythmia with Serious Consequences

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in clinical practice. It is characterised by rapid and irregular electrical activity in the atria, resulting in an irregularly irregular ventricular response. The condition is associated with an increased risk of stroke, heart failure, cognitive decline, and all-cause mortality.

Globally, the prevalence of AF is rising. In Europe, it is estimated that one in four adults over 40 years will develop AF in their lifetime. In Ireland, approximately 50,000–60,000 people are living with the condition, although many remain undiagnosed due to its intermittent and often asymptomatic presentation.

Risk Factors

Key risk factors for atrial fibrillation include:

• Hypertension
• Coronary artery disease
• Heart failure
• Valvular heart disease
• Diabetes mellitus
• Obesity and obstructive sleep apnoea
• Advancing age

Lone AF, without an identifiable underlying cause, is less common and generally carries a lower risk of complications.

Symptoms and Diagnosis

AF can present with a range of symptoms:

• Palpitations
• Fatigue
• Dizziness or light-headedness
• Dyspnoea
• Syncope (less commonly)

However, up to 30% of patients are asymptomatic, and the condition may be discovered incidentally on routine examination or ECG.

Diagnosis is confirmed by ECG showing irregular RR intervals with no distinct P waves. In cases of suspected paroxysmal AF, prolonged rhythm monitoring may be necessary using Holter monitors or wearable devices.

Complications

AF significantly increases the risk of ischaemic stroke — approximately fivefold. Strokes related to AF tend to be more severe, with higher rates of disability and mortality. The condition also contributes to heart failure through tachycardia-mediated cardiomyopathy and impairs quality of life.

Management

Management strategies are broadly divided into:

1. Rate or rhythm control:
   • Beta blockers, calcium channel blockers, digoxin
   • Antiarrhythmic drugs (e.g., flecainide, amiodarone)
   • Electrical cardioversion or catheter ablation in selected cases
2. Stroke prevention:
   • Assessment of thromboembolic risk using CHA2DS2-VASc score
   • Anticoagulation with DOACs or warfarin based on risk stratification
3. Risk factor modification:
   • Blood pressure and glycaemic control
   • Weight loss and treatment of sleep apnoea
   • Reduction in alcohol consumption

AF in Primary Care

Primary care plays a pivotal role in:

• Opportunistic screening (e.g., pulse checks in older adults)
• Initial ECG testing and interpretation
• Long-term anticoagulation management and monitoring
• Patient education on symptom awareness and stroke prevention

Conclusion

Atrial fibrillation is a common and clinically significant arrhythmia with substantial health implications. Early detection and appropriate management can reduce the risk of stroke and other complications. Strengthening primary care's role in screening, diagnosis, and long-term management is essential to improving outcomes at the population level.

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