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

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) 30680

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.

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? 30426

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.

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 29617

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.

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? 29359

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.

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 27558

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.

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 27535

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

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 25892

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

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)? 25531

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

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 25158

This ECG is from a woman in her 80s who presented with a 4 day history of RUQ pain on a background of known gallstones. 

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? 19557
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 18853

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

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