Mechanism

• Factors that trigger the onset  patients with frequent, self-

terminating episodes
• Factors that perpetuate the arrhythmia  patients with AF that
doesn’t terminate spontaneously

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Mechanism
1. continuous aging or degeneration of atrial tissue and the cardiac conduction
system;
2. progression of structural heart disease, such as valvular heart disease and
cardiomyopathy;
3. myocardial ischemia, local hypoxia, electrolyte derangement, and metabolic
disorders (e.g., atherosclerotic heart disease, chronic lung disease,
hypokalemia, and hyperthyroidism);
4. inflammation related to pericarditis or myocarditis, with or without cardiac
surgery;
5. genetic predisposition; and
6. spontaneous or drug-induced autonomic dysfunction.
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Mechanism of Initiation of AF
• PACs that initiate AF
• Focal tachycardia
• Studies  AF begins with a rapid focal ativity in the PVs (most
common), in SVC, CS (less common)

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Mechanism of Maintenance of AF
• Multiple of Wavelets Hypothesis
• Multiple randomly wandering wavelets that collided with each other that
continually reexcited the atria
• Four to six independent wavelets are required
• Mother circuit
• A single source of stable reentrant activity
• Anatomical obstacles (scar, orifices)  break up the wavefront from the
mother circuit into multiple wavelets that spread in various directions

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• Focal Drivers with Fibrillatory Conduction
• a single, rapidly firing focus could be identified with EP mapping.
• Initated by ectopic focal activity

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ECG Features
• Atrial activity
• Rapid and irregular atrial fibrillatory waves (f waves) and lack of clearly
defined P waves
• Best seen in V1, and inferior leads. Less of ten in I and Avl.
• Fibrillatory rate between 350-600/min
• F waves can be fine (<0,5 mm) or coarse (> 0,5 mm)
• R-R intervals are irregular

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