Cardiovascular12 UKMLA questions
Atrial Fibrillation — UKMLA Revision Notes
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, characterised by disorganised atrial electrical activity leading to an irregularly irregular pulse. It is a major risk factor for stroke and systemic thromboembolism.
Key Facts
- Irregularly irregular pulse — the hallmark clinical finding
- Most common sustained arrhythmia; prevalence increases with age
- Major risk factor for ischaemic stroke (5× increased risk)
- CHA₂DS₂-VASc score guides anticoagulation decisions
- Rate control vs rhythm control are the two main management strategies
Investigations
- 12-lead ECG: absent P waves, irregularly irregular QRS complexes
- Echocardiogram: assess left atrial size, valvular disease, LV function
- TFTs: exclude thyrotoxicosis as a precipitant
- FBC, U&E, LFTs: baseline before anticoagulation
- Holter monitor: if paroxysmal AF suspected
Management
- Rate control: beta-blockers (bisoprolol) or rate-limiting CCBs (diltiazem) — first-line per NICE NG196
- Anticoagulation: DOACs (apixaban, rivaroxaban) preferred over warfarin for non-valvular AF
- CHA₂DS₂-VASc ≥2 (men) or ≥3 (women): anticoagulate
- Rhythm control: DC cardioversion or flecainide/amiodarone
- Catheter ablation: for symptomatic paroxysmal AF refractory to medication
NICE Guideline: NICE NG196 — Atrial fibrillation: diagnosis and management (2021)
Related UKMLA Conditions
Heart FailureStrokeHypertensionMitral Stenosis