[Clinical aspects and prognosis of atrial fibrillation]

Atrial fibrillation is alleged to be one of the most frequently occurring arrhythmia. Many patients with atrial fibrillation are asymptomatic. Others, however, complain of palpitations and paroxysmal atrial tachycardias. And especially in patients with preexisting heart failure, atrial fibrillation can lead to a clear worsening of cardiac output. Not only rheumatic but nonrheumatic atrial fibrillation as well are associated with an increased risk of thromboembolic complications. Arterial hypertension, a history of thromboembolism as well as signs of heart failure are clinical parameters which additionally increase the risk of embolism. On the other hand, this increased risk does not hold true for younger patients with idiopathic atrial fibrillation and is also low in patients with only one additional risk factor. Thus, it would indeed be false to anticoagulate every patient with atrial fibrillation. In each case, a careful individual risk stratification including an extensive history and detailed clinical examination should be performed before deciding on antithrombotic therapy.