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Atrial fibrillation 

Atrial fibrillation
Atrial fibrillation

Dr Luke Tapp

and Gregory Lip

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date: 23 January 2021

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia affecting 1–2% of the UK population. Prevalence increases with advancing age, indicating its significance as the global demographic leans towards a more elderly population. Consequently, prevalence is predicted to double in the next 50 years. However, the increasing prevalence of AF is multifactorial, and not solely related to an ageing population. Atrial fibrillation accounts for 1% of overall healthcare expenditure in the UK and is therefore an increasingly important public health issue.

Atrial fibrillation is associated with substantial morbidity and mortality. Far from being a benign arrhythmia, the risk of death is doubled by AF, which is independent of other cardiovascular risk factors. Additionally, AF can also decrease quality of life, with multiple debilitating symptoms, including shortness of breath, palpitations, fatigue, and often frequent hospital admissions. The most devastating complication of AF is the association with an increased risk of stroke. Strokes secondary to AF are more likely to be fatal, result in more severe disability, and be recurrent.

Great advances have been made in our understanding and management of AF in recent times. Identification of risk factors for stroke and development of risk stratification tools has promoted higher uptake of warfarin in patient groups, with clear evidence of benefit, especially in the elderly. Conversely, the recent identification of a user-friendly scoring system to assess the risk of haemorrhagic complications from anticoagulation has refined yet further the indications for warfarin. There have been great leaps forward recently in drug development, with novel antithrombotic agents and a safer antiarrhythmic drug. Perhaps most importantly, the wait for a warfarin substitute, which has been the gold-standard drug for stroke risk reduction for over 50 years, is now over.

The advancements in our understanding and management of AF have been underpinned by several pivotal papers which are discussed in this chapter. They include papers describing important epidemiological advances, novel medications, and management concepts. These ‘landmark’ papers have been chosen as they have clearly made an impact on our understanding of the disease and/or changed our clinical management.

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