Intended for healthcare professionals

Education And Debate


BMJ 1995; 311 doi: (Published 18 November 1995) Cite this as: BMJ 1995;311:1361
  1. Gregory Y H Lip,
  2. D Gareth Beevers

    Atrial fibrillation is the commonest sustained disorder of cardiac rhythm. When it is present many prognostic and therapeutic implications exist as overall morbidity and mortality increase appreciably. Despite this, atrial fibrillation is sometimes regarded as a fairly trivial and unimportant disorder and is often neglected, probably because many patients have few symptoms. In fact, some patients with chronic atrial fibrillation may require long term treatment with potent antiarrhythmic and anticoagulant drugs, which may have important pharmacological interactions and adverse effects. In addition, treatment differs importantly for chronic and paroxysmal atrial fibrillation and for atrial fibrillation, atrial flutter, and the other supraventricular arrhythmias.

    “When the pulse is irregular and tremulous and the beats occur at intervals, then the impulse of life fades; when the pulse is slender (smaller than feeble, but still perceptible, thin like a silk thread), then the impulse of life is small.”

    Huang Ti Nei Ching Su Wen

    Atrial fibrillation is encountered in many clinical settings. It may, for example, be discovered incidentally in an asymptomatic patient, develop in a patient who merely has a chest infection, or be found in a patient with a ventricular rate of 200 beats/min who is too lightheaded to stand up. Patients admitted with atrial fibrillation may have many cardiorespiratory symptoms and clinical features, including syncope and stroke.

    Presenting symptoms in emergency admissions with atrial fibrillation


    Chest pain--34%


    Dizziness or syncope--19%

    A brief history

    Perhaps the earliest description of atrial fibrillation is in The Yellow Emperor's Classic of Internal Medicine (Huang Ti Nei Ching Su Wen). The legendary emperor physician is believed to have ruled China between 1696 and 2598 BC. The poor prognosis associated with chaotic irregularity of the pulse was clearly acknowledged by most of the ancient physicians, but in recorded history, William Harvey in 1628 was probably the first to …

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