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Atrial fibrillation is the most common sustained arrhythmia, affecting 2% of the population and about 10% of those aged >80 years,1 and accounts for 1% of all National Health Service expenditure in the UK.2 Atrial fibrillation coexists with common conditions, both cardiovascular (such as hypertension, heart failure, coronary artery disease and diabetes mellitus) and non-cardiovascular (thyroid disease, chest disease, etc), as well as with an increasingly older general population.1 Indeed, hospitalisation rates for atrial fibrillation have increased by nearly 2–3-fold.1 Thus, atrial fibrillation (and its comorbidities) will become an increasing healthcare burden.
The importance of this arrhythmia is reflected by the considerable morbidity and mortality associated with it. As atrial fibrillation is often asymptomatic, it is often diagnosed only when it has caused a (potentially serious) complication, such as an ischaemic stroke.
Appreciation of the clinical subtypes of atrial fibrillation may guide the approach to subsequent management. Atrial fibrillation is considered recurrent when a patient develops two or more episodes, which may be “paroxysmal” if they terminate spontaneously (defined by consensus as 7 days) or “persistent” if the arrhythmia requires electrical or pharmacological cardioversion for termination. Successful termination of atrial fibrillation does not alter the classification of persistent atrial fibrillation in these patients. Longstanding atrial fibrillation (defined as over a year) not successfully terminated by cardioversion, or when cardioversion is not pursued or deemed inappropriate, is classified as “permanent” (fig 1).
Screening for atrial fibrillation was outwith the scope of the National Institute for Health and Clinical Excellence (NICE) guideline, but was recently addressed in the Screening for Atrial Fibrillation in the agEd (SAFE) study, which reported, in terms of a screening programme, that the only strategy that improved on routine practice was opportunistic screening, rather than targeted screening.3 As …