Atrial fibrillation: diagnostic and treatment

1. Big picture

Atrial fibrillation (AF) is the most common sustained arrhythmia. The ECG pattern is simple but exam-critical:

Irregularly irregular rhythm + no organized P waves = atrial fibrillation

The danger of AF is not only palpitations. The two major clinical problems are:

1. Fast, irregular ventricular response → dyspnea, chest pain, hypotension, heart failure.
2. Left atrial appendage thrombus → embolic stroke/systemic embolism.

So, in the exam, always answer AF with three parallel decisions:

1. Is the patient unstable? → immediate synchronized cardioversion
2. Stroke prevention? → anticoagulation according to CHA₂DS₂-VASc / CHA₂DS₂-VA
3.