Atrial fibrillation

Atrial fibrillation is a common arrhythmia with absent P waves and irregular (irregularly irregular) QRS complexes. The baseline may have coarse or fine fibrillation waves. It is caused by multiple re-entry circuits at once.

Atrial fibrillation should always be described with the rate of ventricular response, e.g. AF with a rapid ventricular response. Slow AF can be a sign of a sick AV node, if the patient is on no rate-slowing medications.

Atrial fibrilation can be paroxysmal, persistent or permanent. It can also be described as valvular or non-valvular. Treatment options include rate control and rhythm control.

Atrial fibrillation is frequently over-diagnosed by machine interpretation, as it tends to mistake baseline / movement artefact for fibrillation waves. Patients with atrial flutter frequently have periods of atrial fibrillation.

Featured Example

Dr Smith's ECG Blog

References

Related

  • See also: Atrial Rhythms
  • Fibrillation and flutter:
  • Irregularly irregular rhythms:

ECG Library (81)

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In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea 12-Lead Irregular Narrow QRS Tachycardia Tall QRS Widespread ST depression Atrial fibrillation ECG Interpretation CC-BY-NC-SA
ECG Blog #166 (ST-T – AFib – LVH – SVT)

This ECG is from a woman in her 60s who presented in acute heart failure with dyspnoea and intermittent chest discomfort.

This ECG shows atrial fibrillation, LVH and diffuse ST-T changes.

Chest pain Dyspnoea 12-Lead Irregular Narrow QRS Tachycardia Tall QRS Widespread ST depression Atrial fibrillation ECG Interpretation CC-BY-NC-SA
In the ECGquest archives, this ECG has been tagged with: - Loss of consciousness Seizure 12-Lead Irregular Narrow QRS Wide QRS Atrial fibrillation Change in rhythm Dr Smith's ECG Blog CC BY-NC
What is this tachycardia that alternates from wide to narrow to wide?

This ECG is from a patient in their 50s who presented unconscious and tachycardic after a seizure.

This ECG shows alternating wide and narrow complex tachycardias at the same rate, likely due to aberrancy.

Loss of consciousness Seizure 12-Lead Irregular Narrow QRS Wide QRS Atrial fibrillation Change in rhythm Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - 12-Lead Nonspecific baseline artefact Atrial fibrillation Ventricular pacemaker Dr Smith's ECG Blog CC BY-NC
Computer often fails to diagnose atrial fibrillation in ventricular paced rhythm, and that can be catastrophic

This ECG is from an elderly patient who presented with a massive hemiplegic ischemic stroke due to MCA thrombus.

This ECG shows atrial fibrillation with ventricular pacemaker and significant artefact. The AF went undiagnosed.

12-Lead Nonspecific baseline artefact Atrial fibrillation Ventricular pacemaker Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - 12-Lead Irregular Normal rate Tall U waves Wide QRS Atrial fibrillation Hypokalemia Dr Smith's ECG Blog CC BY-NC
Pre-existing Left Bundle Branch Block and Atrial Fib: what is alarming on this routine pre-procedure ECG?

This ECG is from an elderly patient who had a routine pre-procedure ECG.

This ECG shows atrial fibrillation with LBBB (old) and large U waves. The cause was hypokalemia.

12-Lead Irregular Normal rate Tall U waves Wide QRS Atrial fibrillation Hypokalemia Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - 12-Lead Absent P waves Bradycardia Irregular Normal Axis RSR' Wide QRS Atrial fibrillation ECG of the Week CC-BY-NC-SA
ECG of the Week – 1st October 2018 – Interpretation

This ECG is from a man in his 80s who presented feeling generally unwell and nauseous, on a background of chronic atrial fibrillation, diabetes and hypertension.

12-Lead Absent P waves Bradycardia Irregular Normal Axis RSR' Wide QRS Atrial fibrillation ECG of the Week CC-BY-NC-SA
In the ECGquest archives, this ECG has been tagged with: - Dizziness 12-Lead Absent P waves Bradycardia Normal Axis Regular Atrial fibrillation Junctional escape Third degree AV block ECG of the Week CC-BY-NC-SA
ECG of the Week – 17th September 2018 – Interpretation

This ECG is from a woman in her 70s who complained of dizziness on a background of ischaemic heart disease, atrial fibrillation and diabetes.

Dizziness 12-Lead Absent P waves Bradycardia Normal Axis Regular Atrial fibrillation Junctional escape Third degree AV block ECG of the Week CC-BY-NC-SA
In the ECGquest archives, this ECG has been tagged with: - Syncope 12-Lead Fibrillation waves Normal rate Atrial fibrillation Sick sinus syndrome Dr Smith's ECG Blog CC BY-NC
Syncope and Atrial fibrillation in a Healthy 70-something Male

This ECG is from a man in his 70s presented with syncope for 20 seconds. He had no past medical history. He recovered fully.

Syncope 12-Lead Fibrillation waves Normal rate Atrial fibrillation Sick sinus syndrome Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Chest pain Palpitations 12-Lead Anterior ST elevation Irregular J wave Widespread ST elevation Atrial fibrillation Normal ST elevation Dr Smith's ECG Blog CC BY-NC
Palpitations and Chest Tightness: Should You Activate the Cath Lab (or Give Thrombolytics)?

This ECG is from a man in his 20s with palpitations and chest tightness on a background of Wolff Parkinson White syndrome.

Chest pain Palpitations 12-Lead Anterior ST elevation Irregular J wave Widespread ST elevation Atrial fibrillation Normal ST elevation Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Abdominal pain 12-Lead Irregular Short QRS Atrial fibrillation ECG of the Week CC-BY-NC-SA
ECG of the Week – 4th June 2018 – Interpretation
Abdominal pain 12-Lead Irregular Short QRS Atrial fibrillation ECG of the Week CC-BY-NC-SA
In the ECGquest archives, this ECG has been tagged with: - Cardiac arrest 12-Lead Anterior ST depression ST elevation in aVR Atrial fibrillation Multi-vessel disease Dr Smith's ECG Blog CC BY-NC
Cardiac arrest #3: ST depression, Is it STEMI? or is he an ACCESS Trial Candidate?
Cardiac arrest 12-Lead Anterior ST depression ST elevation in aVR Atrial fibrillation Multi-vessel disease Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Dizziness 12-Lead Irregular Left Axis Deviation Narrow QRS Normal rate Atrial fibrillation ECG of the Week CC-BY-NC-SA
ECG of the Week – 19th March 2018 – Interpretation

This ECG is from a man in his 80s who presented with dizziness and an abnormal gait.

Dizziness 12-Lead Irregular Left Axis Deviation Narrow QRS Normal rate Atrial fibrillation ECG of the Week CC-BY-NC-SA
In the ECGquest archives, this ECG has been tagged with: - 12-Lead Normal rate ST elevation in aVR Widespread ST depression Atrial fibrillation Diffuse subendocardial ischaemia Multi-vessel disease Dr Smith's ECG Blog CC BY-NC
ST-Elevation in aVR with diffuse ST-Depression – 25 min later after diltiazem
12-Lead Normal rate ST elevation in aVR Widespread ST depression Atrial fibrillation Diffuse subendocardial ischaemia Multi-vessel disease Dr Smith's ECG Blog CC BY-NC
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