Atrial fibrillation history and symptoms

Atrial Fibrillation Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Approximately 90% of episodes of atrial fibrillation are asymptomatic. The section below describes the constellation of symptoms (usually palpitations) when they do occur.

History

Patients can be grouped into two broad classes:

• Those who are entirely asymptomatic when they are in atrial fibrillation (in which case the atrial fibrillation is found as an incidental finding on an electrocardiogram or physical examination)
• Those who have clear symptoms and can pinpoint the time at which an episode of atrial fibrillation begins and when they revert to normal sinus rhythm.

Symptoms

When symptoms are present, they often include symptoms related to the rapid heart rate:

• Palpitations
• Exercise intolerance due to the rapid heart rate
• Fatigue
• Lightheadedness

More serious symptoms include the following:

• Chest pain if there is underlying atherosclerosis
• Dyspnea, shortness of breath and edema if congestive heart failure is present
• Syncope: Syncope is an uncommon but serious complication that is usually associated with sinus node dysfunction or hemodynamic obstruction, such as valvular aortic stenosis, HCM, cerebrovascular disease, or an accessory AV pathway.
• TIA or stroke: Sometimes the arrhythmia will be identified only with the onset of a stroke or a transient ischemic attack (TIA, stroke symptoms resolving within 24 hours).