Atrial fibrillation (Treatment (Restoration of sinus Rhythm…
- in case of 1st episode , it's not necessary to prescribe antiarrhythmic drugs.
- recurrent AF we use antiarrhythmic drugs to maintain the SR.
- antiarrhythmic drugs: limited effectiveness, side-effects, risk of proarrhythmia.
- the treatment is the same as in atrial flutter.
- 3 main goals: control ventricular rate , restore normal sinus rhythm , assessment the need for anticoagulant
- increase life quality and lifetime
AF < 48h
- During first AF episode:
60% spontaneously convert to Sinus Rhythm
- Restoration of sinus Rhythm
Electrical cardioversion, Pharmacological cardioversion
- Indications for Electrical cardioversion (ECV):
dyspnoea with developing acute heart failure
resistant myocardial ischemia
hypotonia with imminent shock
AF in a patient with WPW syndrome = risk of ventricular fibrillation!
factors triggering the arrhythmia?
Conocomitant disease (hypertension, CHF, diabetes)?
- ECG: baseline (so-called fibrillation or f waves) and no clear P waves. The QRS rhythm is rapid and irregular.
- 24h ambulatory ECG
- Echocardiography:identifies LVH, valvular disease, atrial size, and possible left atrial thrombus.
- Transesophageal echocardiography:
- Chest X-ray: allows evaluation of the lung parenchyma and identifies coexisting lung
- 1: no symptoms.
- 2a: mild symptoms, daily activity not affected by AF symptoms.
- 2b: moderate, daily activity not affected by AF symptoms but pat troubled by symptoms.
- 3: sever, daily activity affected by AF symptoms
- 4 Disabling, daily activity discounted
- 1st diagnosed: never diagnosed before.
- paroxysmal AF: self-limiting, mostly in 48 hours - 7 days
- persistant AF: longer than 7 days(requires cardioversion to stop
- long standing: >/= 1 year
- permanent: accepted by pat and physician (no spontaneous or induced cardioversion)
"lone", primary AF
- excess adrenergic stimulation.
- Atrial fibrosis (RAA system)
- inflammation ( increase CRP with no cause)
- genetic ( connexion gene mutation)
- electrolytes imbalance
- stimulant (alcohol, coffee, amphetamine, cannabis, nicotine)
- in a „healthy heart”, usually in patients < 65y.
- The trigger is located in pulmonary vein ostia.
- Initially paroxysmal in form, then persistent AF due to remodelling resulting from long episodes and additional factors (obesity, hypertension...)
- In some patients no cause can be found, and this group is labelled as ‘lone’ atrial fibrillation.
- 56,5% of patients diagnosed with AF have hight risk factors for CV disease:
age, obesity (25% with af), HTN ( 30-85% AF), diabetes (20), smoking,
- hypertension and heart failure are the most common
- rheumatic heart disease, alcohol intoxication and thyrotoxicosis are the ‘classic’ causes of atrial fibrillation
heart failure, Valvular heart disease
congenital heart diseases (ASD)
Coronary artery disease, Pulmonary disease, including PE
Thyroid dysfunction (hyper/hypo), Obtrusive sleep apnea
chronic kidney disaes
genetics: polymorphisms and mutations
- palpitations, weakness, decreases of exercise capacity
- chest pain, dizziness, syncope, decrease of quality of life
- extrasystoles, or recurring irregular patterns (e.g. Wencke- bach block).
- Asymptomatic AF is more frequent than symptomatic
- Symptomatic – in 33% of patients
increase in mortality, especially among patients with organic heart disease
increase in morbidity and hospitalization rate
impairment of the quality of life
5-fold increase of the risk of ischemic stroke
Thromboembolic events occur with AF and can cause significant morbidity and mortality.
• 2% of general population
• 3-6% of emergency hospital admissions is associated with AF
• Incidence has increased by 13% during last 20 years
- frequent in men
- Directly threatening:
WPW syndrome, heart failure
- continuous, rapid (300– 600/min) activation of the atria by multiple meandering re-entry wavelets, often driven by rapidly depolarizing automatic foci, located within the pulmonary veins.
- Atrial rate is over 400 bpm, but most impulses are blocked at the AV node so ventricular rate is 120–180/minute, but it slows with treatment.
- most common sustained arrhythmia