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Atrial Fibrillation

The most common type of non-sinus tachyarrhythmia is atrial fibrillation.

In this case, disorganized electrical impulses that originate in the atria and pulmonary veins initiate the electrical activity in the conduction system of the heart. This causes what are commonly termed as “irregularly irregular” heart beats.

There is chaotic firing from multiple pacemakers in the heart, leading to a rate that is not predictable from beat to beat. Further, atrial fibrillation is said to have no recognizable P-wave activity. Thus, the timing of the ventricular activity of the heart, seen as the QRS complex of an EKG, will also be irregular.
When a heart is in atrial fibrillation, its two upper chambers, the right and left atria essentially quiver, instead of beating efficiently. This does not allow for complete emptying of the atria and thus, it may become stagnant and coagulate. This can lead to major problems, namely, strokes, transient ischemic attacks (TIAs), and pulmonary emboli (PEs); depending which chamber of the heart has the thrombus in it.

Approximately 15 percent of strokes occur in people with atrial fibrillation. As age increases in a population, so too does the incidence of atrial fibrillation, which peaks at about 3-5% in people over the age of 65.

The most common presenting symptoms of atrial fibrillation are palpitations, dizziness, fast pulse rate, irregularly irregular rhythm, an abnormal S1, chest pain, chronic dyspnea, abnormal jugular venous pressure, fatigue, and impaired exercise tolerance.

Other symptoms related to TIAs and strokes may be the initial symptoms of atrial fibrillation.

Some of the most common causes of atrial fibrillation are long-standing hypertension, congestive heart disease, cardiac valvular lesions, myocardial infarctions, history of coronary artery bypass grafts, hyperthyroidism, alcohol abuse, smoking, diabetes mellitus, and electrolyte imbalances. 

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