In this episode, we review atrial fibrillation (AF), the most common sustained cardiac arrhythmia, and discuss the underlying mechanisms driving its characteristic "irregularly irregular" rhythm. We cover the pathophysiology of chaotic atrial electrical activity, major risk factors including advanced age, hypertension, obesity, heart failure, and sleep apnea, and the growing prevalence of AF in the aging population. Clinically, patients may present with palpitations, fatigue, dyspnea, dizziness, chest pain, or exercise intolerance, while some remain asymptomatic. We break down the diagnostic approach with emphasis on classic EKG findings including absent P waves, fibrillatory baseline activity, and variable R-R intervals. Management focuses on the modern AF-CARE approach, including stroke prevention with anticoagulation, rate and rhythm control strategies, and aggressive risk factor modification.

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