Atrial Fibrillation

What it is

Atrial fibrillation (AF) is a chaotic atrial rhythm producing irregular, often rapid ventricular response. Lifetime risk approaches 1 in 3 in older adults of European ancestry; lower but rising in other populations.

Why it matters

• ~5× increased stroke risk (often disabling).
• ~2× increased dementia risk independent of stroke (perhaps via microembolism and hypoperfusion).
• Heart-failure incidence.
• Reduced exercise tolerance and quality of life.

Modifiable risk factors

• Obesity.
• Hypertension.
• Sleep apnoea.
• Excessive alcohol.
• Hyperthyroidism.
• High-volume endurance exercise in some athletes (the “AF in marathon runners” phenomenon).

Management pillars

1. Anticoagulation based on CHA₂DS₂-VASc; DOACs (apixaban, rivaroxaban, edoxaban, dabigatran) generally preferred over warfarin.
2. Rate control with beta-blocker or non-dihydropyridine calcium-channel blocker.
3. Rhythm control: cardioversion, anti-arrhythmics, or catheter ablation. Early rhythm-control strategy reduces composite cardiovascular events (EAST-AFNET 4).
4. Risk-factor modification: weight loss, sleep apnoea treatment, alcohol moderation can reduce AF burden meaningfully.

Related entries

Cardiovascular disease, Sleep optimization, Alzheimer's disease.