ATRIAL FIBRILLATION

DEFINITION : ABNORMAL HEART RHYTM IN WHICH

CHAMBERS OF THE HEART CONTRACT IN
DISORGANIZED MANNER, PRODUCING AN
IRREGULAR HEART RATE.
ATRIAL FIBRILLATION (AF) IS THE MOST
ABUNDANT FORM OF ARRHYTHMIA
(> 2.000.000 AF PATIENTS IN US)
INCIDENCE OF AF INCREASING BECAUSE OF
AGING POPULATION
AF CAUSES DOUBLING OF MORTALITY AND
CONTRIBUTES TO 15% OF STROKES

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CAUSED BY IMPULSES WHICH ARE
TRANSMITTED TO THE VENTRICLES IN AN
IRREGULAR FASHION OR BY SOME
IMPULSES FAILING TO BE TRANSMITTED.
THIS MAKES THE VENTRICLES BEAT
IRREGULARLY, WHICH LEADS TO AN
IRREGULAR (AND USUALLY FAST) RHYTM.
UNDERLYING CAUSES : DYSFUNCTION OF
SINUS NODE, HEART AND LUNG
DISORDERS

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SYMPTOMS
SENSATION OF FEELING HEART BEAT (PALPITATIONS)
PULSE MAY FEEL RAPID, RACING, POUNDING, FLUTTERING,
OR IT CAN FEEL TOO SLOW
PULSE MAY FEEL REGULAR OR IRREGULAR
DIZZINESS OR LIGHTHEADEDNESS
FAINTING
CONFUSION
FATIGUE
SHORTNESS OF BREATH
BREATHING DIFFICULTY, LYING DOWN
SENSATION OF TIGHTNESS IN THE CHEST

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CLASSIFICATION
ACUTE
PAROXISMAL
CHRONIC
DIAGNOSTIC PROCEDURES
ECHOCARDIOGRAM
NUCLEAR IMAGING TESTS
CORONARY ANGIOGRAPHY
EXERCISE TREADMILL ECG
ELECTROPHYSIOLOGIC STUDY (EP STUDY)

EKG AF

WHAT RHYTHM IS THIS?

EKG AF

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WHAT ARE THE MANAGEMENT
ISSUES?
NORMAL VERSUS IMPAIRED HEART.
RATE CONTROL.
ANTICOAGULATION.
CARDIOVERSION (MEDICAL VS.
ELECTRICAL).

HOW DO WE TREAT OUR PATIENT?

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RATE CONTROLLING AGENTS
CALCIUM CHANNEL BLOCKERS:
- IV DILTIAZEM 0.25 MG/KG (10-15 MG)
BOLUS, CAN REPEAT WITH 0.35 MG/KG.
- IV VERAPAMIL 5 MG BOLUS Q 15 MIN TO
MAXIMUM 30 MG.

BETA BLOCKERS:
BLOCKERS
- IV ATENOLOL 5 MG OVER 5 MINUTES, CAN
REPEAT TO MAXIMUM 15 MG. 50 MG PO
BID IF IV WORKS.

DIGOXIN:
- IV LOAD 0.5 MG THEN 0.25-.5MG PO OD

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ANTICOAGULATION:
RECOMMENDATIONS >48 HOURS.
(ANTICOAGULATE FIRST)
1-3 WEEKS OF ANTICOAGULATION BEFORE AND
4 WEEKS OF ANTICOAGULATION AFTERWARDS.
RATE OF THROMBOEMBOLIC EVENTS 0.5-1%

ELECTRICAL CARDIOVERSION:
SYNCHRONIZE, START AT 100-200 JOULES (CAN
GO UP TO 360 JOULES)
REQUIRES CONSCIOUS SEDATION
SAFEST AND QUICKEST METHOD