ECG education

Recurrent atrial fibrillation in a 73-year-old woman

Vivienne Miller




Articles in this section are inspired by, but not based on, real cases to illustrate the importance of knowledge about ECGs in relation to clinical situations in general practice. Management is not discussed in detail.

Key Points

  • The most common associations with atrial fibrillation (AF) include hypertensive heart disease, heart failure, valvular heart disease, ischaemic heart disease, obstructive sleep apnoea, obesity, excessive alcohol consumption, thyrotoxicosis and many lung diseases.
  • The CHA2DS2-VASc score utilises the following risk factors, specifically in patients who have nonvalvular AF: – congestive heart failure – hypertension – age – diabetes – past stroke or transient ischaemic attack – vascular disease – female sex.
  • If oral or intravenous medication (e.g. digoxin, calcium antagonists, beta blockers) to slow the heart rate pending spontaneous reversion; none of these medications control the rhythm in patients who have AF, just the rate.
  • It is important to discuss with the patient in advance if they would prefer to use a rhythm or rate control strategy.
  • Direct current or chemical cardioversion, aimed at rhythm control, is used for symptomatic patients and those with a reasonable prospect of maintaining sinus rhythm.
  • Pulmonary vein isolation ablation is most frequently used in patients who fail to respond to medical therapy, in those who have contraindications or complications from oral antirrhythmic therapy, and in younger patients with no underlying cardiac disease and with a paroxysmal pattern of AF (as long-term success is higher).