Atrial Fibrillation

AF is detected only after the patient presents with serious complications of AF AF incidence and prevalence increase with increasing age. as well as stroke and other morbidities AF is the commonest sustained cardiac arrhythmia Too often.Introduction ` ` ` ` AF is a significant risk factor for mortality. .

Symptoms of AF ` Rate related   Palpitations Reduced exercise tolerance Lethargy Reduced exercise tolerance Stroke ` Loss of atrial contraction   ` Thrombo-embolism  .

rhythm-control Antithrombotic therapy as appropriate Follow-up and review ` ` ` . including risk stratification for stroke/thromboembolism Development of a management plan ² rate-control.What needs to happen ` ` Accurate diagnosis of AF using an ECG Further investigations and clinical assessment.

Ventricular response is irregularly irregular and may be fast (HR >100 bpm.ECG finding ` ` ` ` P waves:rapid oscillations or fibrillatory waves that vary in size. indicates inadequate rate control). . A regular ventricular response with A-fib usually indicates complete AV block with an escape or accelerated ectopic pacemaker originating in the AV junction or ventricles (i. it resembles an old saw (when compared to atrial flutter that often resembles a new saw). moderate (HR = 60-100 bpm). or slow (HR <60 bpm.. and timing. indicates excessive rate control. shape. AV node disease.e. or drug toxicity). must consider digoxin toxicity or AV node disease).




Classification of AF Terminology Initial event (first detected episode) Paroxysmal Clinical features Symptomatic Asymptomatic Onset unknown Spontaneous termination <7 days and most often <48 hours Not self-terminating Lasting >7 days or prior cardioversion Not terminated Terminated but relapsed No cardioversion attempt Persistent Permanent (µaccepted¶) .

Management ` GOALS ` ` ` Hemodynamic stabilization Ventricular rate control Prevention of embolic complication .

. Ischemic heart dz Spontaneous conversion to sinus rhythm CHF Hyperthyroidism PE Yes No Lung ca Alcohol Assess cause of Hypothermia Contraindication to cardioversion? atrial fibrillation Electrolytes imbalance Etc. Cont· .Patient with diagnosis of atrial fibrillation Hemodynamically stable Yes Control ventricular rate: Diltiazem ‡Beta Blockers ‡Calcium Channel blockers ‡Digoxin ‡Amiodarone Long standing HTN No Unstable« ‡Hypotension ‡Confusion Cardioversion ‡Angina ‡«.

. .Cont· Yes No Cardiversion Start Heparin IV Warfarin Consider long-term anticoagulation Aspirin <48hs >48hs ‡Later elective cardioversion after 3weeks of warfarin ‡ Early TEEguided cardioversion Yes ‡Immediate medical or electrical Long standing HTN cardioversion dz Ischemic heart CHF Hyperthyroidism Atrial fibrillation persist? PE Lung ca No Alcohol Hypothermia Assess cause of atrial Electrolytes imbalance fibrillation Etc.

Risk Factors for Stroke in AF ` ` ` ` ` ` ` ` ‡ Valvular Heart Disease ‡ Previous TIA/CVA ‡ LV dysfunction ‡ Age >65 ‡ Hypertension ‡ Diabetes ‡ Coronary Disease ‡ Vascular Disease .