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Atrial fibrillation in the military patient: a review
  1. Alys H Hunter1,
  2. AT Cox2,3,
  3. J D'Arcy4,
  4. M Rooms5 and
  5. AJ Camm3
  1. 1MDHU Portsmouth, Queen Alexandra Hospital, Portsmouth, UK
  2. 2Royal Centre Defence Medicine (Birmingham), Queen Elizabeth Hospital, Birmingham, UK
  3. 3Cardiovascular Sciences Research Centre, St George's University of London, London, UK
  4. 4Department of Cardiology, Royal Centre Defence Medicine (Oxford), John Radcliffe Hospital, Oxford, UK
  5. 5Department of Occupational Medicine, Regional Occupational Health Team (North), Duchess of Kent Barracks, Catterick Garrison, UK
  1. Correspondence to Flt Lt Alys Hamilton Hunter, MDHU Portsmouth, Queen Alexandra Hospital, Portsmouth PO6 1LY, UK; alys.maconie{at}


Atrial fibrillation (AF) is the most common sustained atrial arrhythmia, and increases an individual's risk of morbidity and mortality from cardiovascular and thromboembolic events. In this article, we review the pathophysiology and clinical presentations of AF and describe appropriate investigations and management likely to be appropriate for a military population, in line with current National Institute for Health and Care Excellence and European Society of Cardiology guidelines. The implications for the individual's Medical Employment Standard in the UK Armed Forces, with specific reference to specific military occupational activities such as aviation, diving and driving occupationally, are also reviewed.

A 38-year-old Royal Marine Sergeant presents to the medical centre with fatigue, breathlessness and palpitations since waking from sleep 2 days before. He is, otherwise, healthy, and has been a keen footballer and triathlete for 20 years. The night before his symptoms appeared, he was intoxicated with alcohol at a formal dinner. He admits to normally drinking 30 units of alcohol weekly. On examination, his BP is 124/80 mm Hg, and his pulse is fast and irregular. An ECG shows atrial fibrillation (AF) with a ventricular response of 120–140 bpm.


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