ABSTRACT
CLASSIFICATION ■ Paroxysmal-Episodes terminate spontaneously, recur, and
last <48 hours. ■ Persistent-Continuous AF that can be converted to sinus
rhythm ■ Permanent-Ongoing AF refractory to reversion or allowed
to continue
ETIOLOGY ■ Common-ischemic heart disease, dilated cardiomyopathy,
familial, chronic hypertension, valvular disease (particularly rheumatic mitral stenosis), advanced age, postcardiac surgery
■ Other cardiac predictors-presence of left atrial enlargement, left ventricular hypertrophy, ventricular dysfunction, acute myocardial infarction (10% of persons with acute myocardial infarction have an associated episode of AF and up to 20% if they develop congestive heart failure), sinus node dysfunction, hypertrophic cardiomyopathy, WolffParkinson-White syndrome
■ Noncardiac precipitators-hyperthyroidism, alcohol (holiday heart syndrome), severe infection, pulmonary embolism
■ Note: Every patient who presents only with acute onset of AF does not need to be “ruled out for a myocardial infarction or screened for an occult pulmonary embolus.” Although AF may be associated with these conditions, it is quite uncommon in the absence of other clinical clues (symptoms, ECG changes, hypoxia)
EPIDEMIOLOGY ■ AF affects 2.3 million Americans and results in 75,000 strokes
annually. ■ The incidence of AF is estimated at 0.4% of the general pop-
ulation and increases with age: 2%-5% at age 65 and 9% by age 80.
