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THE CARDIOLOGISTS IN HSR LAYOUT Atrial fibrillation Atrial fibrillation is the most common sustained arrhythmia. The atrial activity consists of chaotic, small fibrillatory f waves at 400–700/minute. The ventricular response is usually 130–160/minute and is irregular. The ventricular response rate is slower if the patient has been treated with anti-arrhythmic drugs or if there is intrinsic AV nodal disease. When the response rate is slow, the AF is often reported as ‘controlled’ . very rapid ventricular response—more than 200/minute—may be seen in the presence of a bypass tract, like the bundle of Kent in WPW syndrome (Fig 3.24) or James fibres in LGL syndrome . The AF itself should never be reported as ‘fast’ because it always