A common consequence of atrial enlargement and/or inflammation, atrial fibrillation (AF) is a dysrhythmia originating from the atria, typically recognized on the electrocardiogram. It most commonly presents as a tachyarrhythmia, with ventricular rates between 120-130 beats per minute. Defining electrocardiographic features include; an absence of defined P wave, irregularly irregular R-R intervals, and narrow QRS complexes (in the absence of other conduction system pathology).

Cardiac imaging plays an important role in the identification of the cause, assessment for intervention, and potential thromboembolic complications.

Epidemiology

AF is present in ~5% of patients over 65 years old. The presence of new-onset atrial fibrillation may provide diagnostic assistance due to its well-identified associations, which include ²:

• atrial enlargement

  • most commonly left atrial enlargement (of any cause)

• pericarditis

• acute pulmonary embolism

• thyrotoxicosis

• coronary artery disease

• myocardial ischemia

  • common after acute myocardial infarction

• chronic hypertension

• cardiac surgery

Clinical presentation

Presentation varies based on the underlying cause, but commonly includes;

• palpitations

• shortness of breath

• fatigue

• altered mentation

Treatment and prognosis

Treatment strategy in recently diagnosed cases of AF includes identification and solution of reversible risk factors with anticoagulation therapy followed by beta-blockers ⁴.  One surgical option is the Cox-Maze procedure ⁶.