Bridging Trial Case Study

Bridging Trial Case Study
The BRIDGE trial, conducted by Douketis and associates,1 was a randomized, multicenter, double–
blind, placebo–controlled trial that questioned the need for anticoagulation bridging in patients with
atrial fibrillation, who are undergoing an invasive procedure that requires interruption of warfarin
therapy. The primary efficacy outcome was arterial thromboembolism, which includes stroke,
transient ischemic attack, and systemic embolism, whereas the secondary efficacy outcomes were
acute myocardial infarction, deep–vein thrombosis, pulmonary embolism, and death. The primary
and secondary safety outcomes were major and minor bleeding, respectively. Patients eligible for
this trial must have been 18 years or older, had chronic atrial fibrillation or flutter, been on warfarin
therapy for at least 3 months, had an international normalized ratio (INR) of 2.0 to 3.0, were
undergoing an elective invasive procedure that required discontinuation of warfarin therapy, and had
at least one CHAD2 stroke risk ... Show more content on Helpwriting.net ...
The analysis also demonstrated no significant difference between the groups when it came to the
secondary outcomes: acute myocardial infarction (p=0.1), deep–vein thrombosis (p=0.25),
pulmonary embolism (p=0.25), and death (p=0.88). However, the bridging group had a significantly
higher risk of major (p=0.005) and minor (<0.001) bleeding than the placebo group. Overall, the
authors concluded that, in patients with atrial fibrillation undergoing invasive procedures, forgoing
bridging was noninferior to bridging with a low–molecular–weight heparin for atrial
thromboembolism prophylaxis and that there was a clinical benefit in forgoing bridging due to the
lower risk of major and minor
... Get more on HelpWriting.net ...

Atrial Fibrillation with No Structural Heart Disease...
BACKGROUND
Approximately 10% to 30% of patients with atrial flibrillation (AF) do not present structural heart
disease or have a comorbidity such as hypertension. Atrial fibrillation is the most frequent
arrhythmia in daily practice that occurs under diverse situations and its treatment should be based on
the different scenarios of presentation. Severe population–based studies have found that AF is
associated with greater morbidity and mortality and worse quality of life. It is the leading cause of
arrhythmia–related hospitalizations with an important impact on medical costs.
Radiofrequency catheter ablation steadily progresses as an option therapy to cure atrial fibrillation.
The indications of catheter ablation are increasing due to a ... Show more content on Helpwriting.net
...
5) Only 12% of AFFIRM patients did not have structural heart disease, constituting a small group
that should have undergone long–term follow–up to demonstrate the presence of differences.
The low mortality rate observed in patients without heart disease, even in the absence of an effective
therapy, makes it difficult to demonstrate any variation in the prognosis. The basic objective in these
patients is to improve symptoms and quality of life, to avoid the adverse effects of antiarrhythmic
agents and to cure the arrhythmia in order to prevent the development of atrial dilation, need for
anticoagulant therapy and increased risk. In population–based studies, as the Framingham study, the
presence of AF increased long–term mortality 1.5 to 1.9 times.
WHAT ABOUT THE RISK OF EMBOLISM?
The risk of embolism is one of the major problems in patients with AF. The annual risk of stroke in
patients with a CHADS score = 0 is low, 0.36%; yet, the risk or stroke exists. Interestingly, patients
with persistent or chronic lone AF have a risk of embolism of 1.3% per year, and this percentage
may be low but not absent, especially if we bare in mind the cumulative risk. (4) Although this
controversy deals with patients without structural heart disease, patients with AF frequently have
hypertension, a condition that increases the risk of embolism (CHADS 1). Oral anticoagulant agents
or aspirin

Atrial Fibrillation Analysis
Atrial Fibrillation and its inception are due to innovative health professionals who sought to treat
their patients. Dr. Melvin Scheinman performed the first catheter ablation in humans in 1981. Dr.
Melvin also utilized high–energy DC shocks to generate scars in his patient's heart compared to
today's popularized RF energy. Dr Scheinman still remains as an active member of the
electrophysiology group at the University of California San Francisco (UCSF). Dr Scheinman's
work has also led to the development of radiofrequency energy catheters. The UCSF radiofrequency
energy catheters channel radiofrequency energy to heat the catheter tip and perform much more
precise ablation than was possible with DC ablation. Cather ablation has been used for

Why Is Atrial Fibrillation ( A Fib ) Is The Most Common...
When one begins to discuss issues that arise with an intrinsic organ, things get serious.
Unfortunately, vital organs like the heart and liver that are causing problems can't be removed like
the appendix or the kidney and "cure" people of issues such as Appendicitis or constant dealings
with gallstones. This is true when things begin to go awry within the heart and conditions begin to
arise. Atrial Fibrillation (A–fib) is the most common type of arrhythmia, or issue with the heart rate
or rhythm. Though A–fib is not a condition that is life–threatening, depending on the severity and
lack of treatment, this condition leads to more serious issues like heart disease, and even heart
attacks and strokes, which are usually what end up being the cause of death in individuals diagnosed
with the condition. Because of A–fib leading to other more detrimental problems, such as the ones
listed above, it is difficult to identify and pinpoint if someone has it or had it, which is why it is
known as one of the contributors to the "silent killer," also known as the heart attack. In this paper,
gaining a deeper understanding of Atrial Fibrillation will be accomplished through the exploration
of: causes, diagnosis, symptoms and treatment, the variation of types, what all is affected within the
body as a result, what happens physically, and what occurs at the cellular level when diagnosed with
this disorder. All in all, Atrial Fibrillation should be taken seriously and further research is

Why Atrial Fibrillation Occur
There no direct cause as why to atrial fibrillation occur but, there is many other disease and
disorders that Atrial Fibrillation is associated with. For example Atrial Fibrillation is closely
associated with heart attack due to the fact that a during a heart attack the coronary artery is unable
to supply oxygen to the heart which then causes the muscles in the heart to starve for oxygen. This
can then lead to the death of some muscle tissue in the heart which then can lead to AFib.
Hypertension also play a role in AFib, Hypertension (high blood pressure) is a constant high
pressure of blood against the walls of the artery (arteries are the blood vessel that carry blood from
the heart to our body parts) (A blood vessel is a tube which carries

Atrial Fibrillation Case Study
1. Introduction: Atrial fibrillation (AF) is an irregular and rapid heart rate that disrupts normal blood
flow from atria to ventiricles and ultimately to the rest of the body. In AF, the hearts upper champers
beat irregularly which might lead to the formation of blood clots and ischemia(1). AF is one of the
most common cause of population mortality and morbidity with an estimated prevalence of about 1–
2% in the developed world. The incidence and prevalence increases parallel to age reaching up to
10% over the age of 80 (2–4). AF prevalence in Australia seems to be similar with the rest of the
world, affecting more than 300,000 as per 2011 reports. Additional studies in Australia have
indicated that the trend of hospitalization due to ... Show more content on Helpwriting.net ...
NOACs are considered to be ideal for prevention of stroke associated with AF and other
thromboembolic conditions. Some of the prominent advantages include their predicatable
pharmacodyanmic and pharmacokinetic profils, relatively wider therapeutic window that do not
require routine monitoring, limited drug interaction and have no dietary restrictions(17). Results
from clinical trials showed that NOACs such as thrombin inhibitors (dabigatran), and factor Xa
inhibitors (rivaroxaban, apixaban) were found to be at least as effective as warfarin in preventing AF
related stroke. Most importantly, intracranial bleeding, the most severe side effect of warfarin was
found to be less prevalent in patients treated with NOACs (18–21). In view of such findings,
NOACs seem to have an important share in the management of patients with AF. However, use of
warfarin for thromboprophylaxis is still considered to be vital as there are certain issues related with
the use of NOACs in AF. Warfarin has been used for a couple of decades resulting in extensive
experience for prevention of thromboembolism. Some pharmacokinetic controversies regarding
NOACs include; shorter acting than warfarin, hence missed doses could increase the risk of
thrombosis. Moreover, NOACs have no specific antidotes to reverse their therapeutic effect. One
study

Atrial Fibrillation (AF)
Atrial Fibrillation (AF) is reaching epidemic proportions and is having a major impact on the public
health system. This essay will explore the prevalence of AF and will describe the aetiology,
pathophysiology and the risk factors of this arrhythmia. It will use evidence based practices to
describe the current treatment modalities used for AF, along with the appropriate nursing
interventions in order to prevent any complications and thus, resulting in an improved quality of life
for the patient. Furthermore, the essay will be exploring topics regarding the relevant education and
lifestyle modifications. In Australia, the estimated prevalence for AF affects approximately 2% of
the total general population (Medi, Hankey, & Freedman, 2010). Studies

Therapy For The Elderly With Atrial Fibrillation Essay
ANTICOAGULATION THERAPY FOR THE ELDERLY WITH ATRIAL FIBRILLATION
ANTICOAGULATION THERAPY FOR THE ELDERLY WITH ATRIAL FIBRILLATION
By
Rebecca J Hoistad
Bachelor of Science, North Dakota State University, 2011
Scholarly Project
Submitted to the Graduate Faculty
Of the
University of North Dakota
In partial fulfillment of the requirements
For the degree of
Master of Physician Assistant Studies
Grand Forks, North Dakota
May
2017
TABLE OF CONTENTS
ACKNOWLEDGMENTS?????????????????????.??????..3
ABSTRACT?????????????????????????????...???.4
CHAPTERS
INTRODUCTION?????????????????????????...??6
REVIEW OF LITERATURE???????????????????????..7
Theme 1. Pathology and diagnosis of atrial fibrillation??????????...8
Theme 2. Current anticoagulation therapy for atrial fibrillation???????11
Theme 3. Anticoagulation for patients with multiple diagnoses along with atrial
fibrillation??????????????????????..?????16
DISCUSSION?????????????????????????????18
APPLICABILITY TO CLINICAL PRACTICE???????..????????.19
REFERENCES???????????????????????????????20

ACKNOWLEDGMENTS
I would like to express many thanks for my advisor Daryl Sieg for all of the support. I would also
like to thank Dr. Klug for her guidance in the statistical aspect of this paper. Thank you to Allison
Frank at the coagulation clinic in Fargo for taking the time to discuss my paper with me. Her view
on these medications was very beneficial.
My family has also been a huge support during this whole process.

Essay On Atrial Fibrillation
Atrial Fibrillation
Juli Lee
Institute of technology– Clovis
Introduction
What is atrial fibrillation? Most physicians and people who acquired the problem usually know it as
A–FIB, a shorter term for atrial fibrillation. Atrial fibrillation deals with the cardiovascular system,
in particular, the heart in the body. It is defined as, "the electrical signals that control this system are
off–kilter. Instead of working together the atria do their own thing, causing fast fluttering heartbeat,
also known as arrhythmia" (WEBMD). In a normal pumping blood of the heart the atria would
squeeze first, followed by the ventricles of the heart. A–fib can be a serious issue if not treated, due
to the inadequate pumping of the blood, causing a higher chance of heart failure. It is also a higher
chance in getting a stroke, because improper flow of the blood can cause clots in the ... Show more
content on Helpwriting.net ...
Genetics can be another causing factor of atrial fibrillation, because having a history in the family of
A–FIB can be pass through individuals. Other individuals, whom can have a–fib, can be those who
have certain medical condition such as; COPD, long–term disease, sleep apnea. If anything, most
individuals who don't have any medical and complications of the heart, certain medications can also
cause a risk in having a–fib, such as; adenosine, digitalis, and theophylline. The most common way
to prevent risks of atrial fibrillation is the habits and lifestyle of the individual, staying away from
consuming large amount of alcohol, caffeine, and cigarettes can prevent atrial fibrillation. People
who are experiencing atrial fibrillation should avoid being under stress, or over using of the body, as
it will trigger an episode and worsen the

Atrial Fibrillation Research Paper
What is atrial fibrillation? Atrial fibrillation, also known as afib, is an irregular heartbeat that
produces disorganized electrical signals within the heart. This results in quivering of the atria, or top
chambers of the heart which allows blood to pool. Stagnant blood in the atria increases the risk of
developing a blood clot.1 The blood clot can enter the bloodstream and travel to the brain resulting
in a stroke. Atrial fibrillation is associated with a 5 times increased risk for stroke, and
approximately 15–20 percent of people who experience a stroke have atrial fibrillation.2 Symptoms
of atrial fibrillation are heart palpitations, shortness of breath, weakness, chest pain, dizziness,
nausea, and fatigue.1(p6) The incidence of afib increases ... Show more content on Helpwriting.net
...
Stroke was defined as the sudden onset of a focal neurologic deficit in a location associated with the
area of a major cerebral artery. The primary safety outcome was major hemorrhage and was defined
as a reduction in the hemoglobin level of at least 20 g/L, transfusion of at least 2 units of blood, or
symptomatic bleeding in a critical organ or area. Results were calculated using the Cox
proportional–hazards modeling. Systolic embolism or stroke occurred in 199 patients receiving
warfarin, 182 patients receiving 110 mg of dabigatran twice daily, and in 134 patients receiving
dabigatran 150 mg twice daily. Major bleeding events occurred in 3.36% of participants per year
with warfarin, 2.71% per year in patients that received 110 mg of dabigatran, and 3.11% per year in
those receiving 150 mg of dabigatran. From calculated data, results revealed that dabigatran
administered at a dose of 110 mg twice daily was non–inferior to that of warfarin. Lower rates of
stroke were associated with dabigatran administered at a dose of 150 mg twice daily compared with
that of warfarin. For safety, it was concluded that the risk of bleeding was lowest with dabigatran
110mg twice daily, and was similar between dabigatran 150 mg twice daily and

Atrial Fibrillation Essay
Introduction
Atrial fibrillation (AF) is a cardiac arrhythmia. It is the most common arrhythmia and it has
implications for patients and anaesthetists alike. The anaesthetist must take into consideration the
physiological and pharmacological implications of this common arrhythmia.
In a healthy individual receiving a general anaesthetic, the anaesthetist must be aware of the causes
and treatment of acute onset AF, both intra–operatively and peri–operatively. Patients with AF often
develop a decline in left ventricular performance and other hemodynamic instabilities including
reduced diastolic filling and tachycardia mediated cardiomyopathy1, all of which can reduce cardiac
output and pose difficulties for the anaesthetist.
One of the ... Show more content on Helpwriting.net ...
Atrial remodeling, both structural and electrical, can facilitate reentrant circuits for electrical
current, which can then lead to permanent fibrillations. The main mechanism proposed for electrical
remodeling leading to permanent AF is shortening of the refractory period7.
Postoperative atrial fibrillation (POAF) is a common problem seen by anaesthetists and patients
who develop POAF have a worse outcome8. Developing POAF puts patients at risk of
hemodynamic derangements, postoperative stroke, perioperative myocardial infarction, ventricular
arrhythmias, and heart failure8.
In cardiothoracic surgical patients, an incidence of as high as 16–46% has been reported8. This is
related to a number of factors that can be encountered during surgery. Mechanical factors like
manipulating the heart, pain and sympathetic stimulation can all induce POAF. It can also be related
to systemic inflammatory processes, hypotension, hypoxia, anemia and metabolic alterations. These
situations can all be expected during anaesthesia. Volatile agents used during anaesthesia may also
have antifibrillatory action8.
Another interesting cause of AF is a familial cause. Olson et al (2006) investigated a hereditary
predisposition to AF involved a nonsense mutation in the KCNA5 gene. This gene encodes kv1.5.
kv1.5 is an atrial specific potassium channel. The group reported a novel genetic basis for idiopathic
AF seen in patients lacking traditional risk

Cardiovascular Case Study Examples
Cardiovascular Case Study: Atrial Fibrillation and Oral Anticoagulation
Scenario
You are the nurse working in an anticoagulation clinic. K.N. is a patient who has a longstanding
irregularly irregular heartbeat (atrial fi brillation, or A–fi b) for which he takes the oral anticoagulant
warfarin (Coumadin). Recently, K.N. had his mitral heart valve replaced with a mechanical valve.
You know that there are different PT/INR (prothrombin time/International Normalized Ratio) goal
recommendations based on the indication for anticoagulation. (NOTE: PT has now been replaced by
or is reported, in most cases, with INR [International Normalized Ratio], an international value that
allows for laboratory standardization. PTT is more properly written ... Show more content on
Helpwriting.net ...
Because you are at risk for bleeding, bruising, hemorrhaging. We need to give you vitamin K to
reverse the effects of the Coumadin and it takes 12– 24 hr before the vitamin K starts to work. We
need to know what your levels are once it kicks in.
6. K.N.'s INR the next day is 3.7. Although the INR is a little elevated, the provider made no further
medication changes. K.N. is instructed to fi nish the remaining 2 days of antibiotics and return again
in 7 days to have another PT/INR drawn. Why should the
INR be checked again so soon instead of the usual monthly follow–up?
Because the effects of vitamin K last for 1 week and the patient will not respond normally to
Coumadin for the entire week. We need to know where his INR is after the vit. K wears off.
7. K.N. grumbles about all the lab tests but agrees to follow through. The next INR is 2.8.
What patient education needs to be stressed at this visit? Identify two education needs.
You need to explain to him the s/s of blood clotting (since he may have too low an INR d/t treatment
and he needs to know this). Explain that his a–fib puts him at risk for blood clots.
Explain that he is also at risk for bleeding, so only use a soft tooth brush, electric razor, and tell the
doctor if he has black, tarry stools.
8. Six months later, K.N. informs you that he is going to have a knee replacement next month. What
should you do with this information?

Make sure you contact his knee surgeon to

Atrial Fibrillation: A Case Study
Introduction
As the most common cardiac arrhythmia, atrial fibrillation (AF) significantly increases the risk of
ischemic stroke.(1) Anticoagulation is an important management approach to lower the risk of
thromboembolism in AF.(2) Warfarin has been the mainstay of oral therapy to prevent stroke in AF
patients for over 60 years.(3) A meta–analysis of nonvalvular atrial fibrillation shows that warfarin
has a 64% reduction in the relative risks of stroke and 26% for all–cause mortality.(4) Owing to the
need for systematic monitoring for international normalized ratio (INR) and the risk of various types
of bleeding, warfarin is underutilized.(5) Patients who receive warfarin only spend 63.6% of the
treatment time in the therapeutic range.(6)

Warfarin Therapy Research Paper
There has been much debate between physicians about the need for heparin or a low–molecular–
weight heparin (LMWH) use when initiating warfarin therapy for anticoagulation. The use of
heparin or a LMWH when initiating warfarin therapy has been justified by a theoretical possibility
of a transient hypercoaguable state from the warfarin use. Many physicians believe that the only
safe and effective way to start a patient on warfarin is with the use of one of these heparins,
however, the hypercoaguable state is just a theoretical possibility. Also, heparin bridging must be
done in a hospital where the levels can be monitored, while a LMWH can be done at home, but is
usually relatively expensive and requires the patient to give themselves injections. ... Show more
Azoulay, Dell'Aniello, Simon, Renoux, and Suissa (2013) performed a post–hoc nested–control
analysis using the United Kingdom's clinical practice research datalink database of 70,766 patients
aged 18 years and older, who were diagnosed with atrial fibrillation between 1993 and 2008.
Patients with less than one year of medical history in the database, as well as patients with a history
of mitral or aortic valve repair or replacement, or patients with a history of hyperthyroidism were
excluded from the study. By using conditional logistic regression, Azoulay et al. (2013) was able to
determine that there was a 71% increase of stroke during the first 30 days of warfarin treatment,
with a decreased risk after the first 30 days. Azoulay et al. (2013) goes on to conclude that warfarin–
naïve patients (patients who have never taken warfarin previously) with atrial fibrillation might have
a greater increased risk for thrombotic events during the first 30 days of warfarin initiation.
Therefore, the study concluded that the increased clotting risk may be due to a warfarin induced
hypercoaguable state, or it may be due to the extended time interval it takes for a therapeutic INR to
be achieved by inexperienced warfarin

Atrial fibrillation can cause significant discomfort (particularly if one has a lot of symptoms) and
this may reduce one's ability to exercise and do daily activities which may affect one's life.
Alternative, atrial fibrillation may not affect one's day–to–day life. Atrial fibrillation is associated
with a decrease in the heart's ability to pump blood (it can result in the development of heart
failure), which can affect one's quality of life, increase the likelihood of being admitted to hospital
and reduce one's life expectancy. Atrial fibrillation itself does not pose a direct and immediate risk
of death and many patients live with the arrhythmia for decades. However, atrial fibrillation can lead
to serious complications. These possible complications ... Show more content on Helpwriting.net ...
Due to this irregularity in the beating of the heart in patients with atrial fibrillation, the flow of
blood is affected. This can cause blood cells to stick together and increases the risk of a blood clot
forming in the upper chambers of the heart (the atria). In people with atrial fibrillation, the most
common place for these blood clots travel to is the brain and this can result in a strike. The bigger
the clot and the larger the blocked artery is, the more devastating the consequences of the strike can
be. If very small clots are dislodged from the main clot in the heart, a mini–stroke (called a 'transient
ischemic attack' or TIA) could occur but the symptoms resolve within a day. It is rare for patients
with atrial fibrillation to develop symptoms from blockages in other arteries, for example a blockage
in the arteries in the heart, resulting in a heart attack. This is because the brain is affected much
more by the loss of its blood supply caused by a blood clot and the brain produces symptoms when
smaller blood vessels are blocked. In addition, there is a large flow of blood to the brain so clots
emerging from the heart are more likely to be directed into the brain than

Atrial Fibrillation Research Paper
Atrial Fibrillation: The Chronic Illness Component
Atrial Fibrillation (AF) is defined as an irregular heartbeat, often of a rapid rate, that causes
insufficient blood flow to the body. During atrial fibrillation, the upper chambers of the heart (atria)
beat chaotically and out of synchronization with the lower chambers of the heart (ventricles). Atrial
fibrillation is the most common sustained arrhythmia, affecting more than 2 million people in the
United States, with an estimated 150,000 new cases being diagnosed each year (Shea and Sears,
2008). The Chronic Illness Trajectory Framework, developed by Corbin and Strauss, focuses on the
patient living with atrial fibrillation and the ability to manage the course of the illness based on ...
Show more content on Helpwriting.net ...
His symptoms started affecting his ability to complete his assigned duties at his job. Due to his
obesity, he was also unable to participate in sporting activities with his 2 children. After a near death
experience with the pulmonary embolism, patient X decided it was time to take control of his life.
He joined a gym, ate healthy and was compliant in taking his medications. One year later, his blood
pressure was controlled, weight was 200lbs and he was feeling better. At this point, his cardiologist
introduced the idea of him proceeding with a radiofrequency catheter ablation to treat the atrial

A New Generational Anticoagulant Drug
A New Generational Anticoagulant
For many year's patients with atrial fibrillation have been treated with anticoagulants such as
Warfarin to prevent strokes and embolisms. Unfortunately, Warfarin must be closely monitored and
that is an irritant for some patients. In October 2010, the FDA approved a new generational
anticoagulant drug called Dabigatran (Pradaxa). This alternate medication gives patients the benefit
of no dietary restrictions since dabigatran is not affected by certain foods. Another benefit of taking
dabigatran is a monthly blood test is not required to measure its effectiveness, so for this particular
reason many patients switch from taking other anticoagulants to dabigatran (Talati & White, 2011).
Since this medication does not require close monitoring, some wonder if is it truly a better option or
can more harm than good come from taking it. While the benefits of using dabigatran have shown
significant improvement over warfarin, there are still risks associated with using dabigatran. Atrial
fibrillation is the most common arrhythmia that puts patients at high risk for ischemic strokes.
Doctors will diagnosis atrial fibrillation by performing an electrocardiogram. The majority of
patients that develop atrial fibrillation are over the age of 65 years old and male. Atrial fibrillation
can be characterized by episodes of either paroxysmal or intermittent depending on frequency and
length of time before spontaneously stopping. It can also be persistent or

Cardiac dysrhythmias come in different degrees of severity. There are heart conditions that you are
able to live with and manage on a daily basis and those that require immediate attention. Atrial
Fibrillation is one of the more frequently seen types of dysrhythmias (NIH, 2011). The best way to
diagnosis a heart condition is by reading a cardiac strip (Ignatavicius &Workman, 2013). Cardiac
strips play an chief part in the nursing world allowing the nurse and other trained medical
professionals to interpret what the heart is doing. In a normal strip, one can clearly identify a P wave
before every QRS complex, which is then followed by a T wave; in Atrial Fibrillation, the Sinoatrial
node fires irregularly causing there to be no clear P ... Show more content on Helpwriting.net ...
If this were to happen over a long period of time it can lead to an overall decreased cardiac output.
Aside from the decreased cardiac output, a potential for blood clots is now present since there is
pooling in the atria chambers (Ignatavicius & Workman, 2013). Stress, surgery, lung disease, and
hypertension, are just a few concerns that can lead to atrial fibrillation (Cleveland Clinic, 2014)
Atrial Fibrillation is divided into three categories: Paroxysmal, which is where heart beat becomes
irregular all of a sudden and then corrects itself quickly; Persistent, where the irregular heart rate
occurs for more than a week, and either clears up on its own or with treatment; and Permanent,
which is where a normal heart rhythm cannot be reestablished with treatment (Cleveland Clinic,
2014). Symptoms of atrial fibrillation can vary depending on the person, and the severity of the
dysrhythmia. Because decreased cardiac output over a period of time is something to worry about, it
is important to assess the patient for fatigue, weakness, shortness of breath, dizziness, anxiety,
syncope, palpitations, chest pain, and hypotension. Some patients are even asymptomatic
(Ignatavicius & Workman, 2013).
Nursing Management
Atrial Fibrillation is a dysrhythmia that can be treated. First

Write An Essay On Atrial Fibrillation
Atrial fibrillation (AF) is a type of irregular heartbeat or dysrhythmia. Atrial fibrillation can be
something that happens every now and sometimes you may develop atrial fibrillation that doesn't go
away and needs to be treated. Symptoms of atrial fibrillation usually include heart palpations,
dizziness or light–headedness, and a feeling of fluttering or "butterflies" in the chest. Although AF
may be asymptomatic, up to two thirds of patients report that the arrhythmia is disruptive to their
lives (Markides, 2003). Atrial fibrillation can a lot of the time lead to more serious complications
such as stroke, and other heart diseases.
In a healthy heart, the sinoatrial node sends an electrical impulse through the atria to contract and
pump blood into the ventricles. During atrial fibrillation the normal function of the heart is
disrupted. It starts with a chaotic electrical discharge in the atria of the heart, which then causes an
irregular, rapid atrial contraction – which leads to rapid ventricular conduction in the AV node.
Diseases that damage the heart or abnormalities of the heart's structure are the most common cause
of atrial fibrillation. Certain factors increase the risk of developing atrial fibrillation, such as age,
heart disease, high blood pressure, obesity or family history.
Depending on ... Show more content on Helpwriting.net ...
It is important to educate the patient about the side effects of each medication. Because most
patients with atrial fibrillation are sent home on anticoagulants it is important to teach the signs and
symptoms of bleeding, and to make sure they understand how vital it is to have lab work drawn
because the dosage of the medication may need to be adjusted depending on the results. It is very
important the patient understands not to use any aspirin products. Patients should understand the
importance of follow up visits, so that the physician can continuously monitor their heart

Atrial Fibrillation Paper
A systematic review of the literature on...
Radio Frequency Cardiac Ablation Therapy as First Line Treatment for Paroxysmal Atrial
Fibrillation vs. Anti–Arrhythmic Drug Therapy.
The Capstone Project
Presented to
The Faculty of the Division of Physician Assistant Studies
Long Island University
In Partial Fulfillment of the Requirements for the Master of Science Degree in Physician Assistant
Studies
By
Boris David Fuzaylov
07/06/2015
Introduction Atrial fibrillation (AF) is the most common sustained heart rhythm disturbance in the
United States, affecting over 2 million individuals with over 150,000 new cases of AF being
diagnosed each year. Approximately 4% of the population over the age of 65 is affected. As a person
ages, ... Show more content on Helpwriting.net ...
Most focal AF is initiated by premature beats from the orifices of the pulmonary veins or from the
myocardial sleeves inside the PV's, and radio frequency catheter ablation of triggered foci has been
shown to cure AF. 14 Experts in catheter ablation have acknowledged that pulmonary vein isolation
is the primary approach for patients with AF. It has been noted that pulmonary vein ostial ablation
may result in pulmonary vein stenosis, which is why most conductors have discussed going away
from the ostium and towards the antrum of the pulmonary vein.14 The antrum blends into the
posterior wall of the left atrium and to be able to include most of the pulmonary vein, ablation must
be performed around the entire antrum along the posterior left atrium wall.14 A recent meta analysis
of 31 studies including 2,800 patients found that the single procedure success rate of pulmonary
vein isolation of all types of AF without anti arrhythmic drugs was 57%.14 An analysis of 34 studies
enrolling a total of 3,481 patients show that the success rate without anti arrhythmic drugs increased
to 71% after multiple procedures.14 However, examining data from 6 pioneering centers with
greater experience in AF ablation, the success rate without anti arrhythmic drugs was 81% in 1,039
patients followed up for a period of 6 months to 2.4 years.14 Recently, two 5 year follow up studies
reported that single procedure success rates without

Atrial Fibrillation And Heart Failure
Introduction There are approximately 5.7 million people in the United States diagnosed with heart
failure and about half of those diagnoses will die due to causes related to heart failure within five
years ("Heart Failure", 2016). Heart failure related deaths vary by geographic locations; however,
they are most predominant among men and offer a greater risk to women if left untreated. Heart
failure is a serious medical condition, if diagnosed and treated early enough, the chance of
preventing death increase.
Heart failure is a syndrome where the heart lacks the ability to pump blood effectively throughout
the body for a prolonged period. It often co–exists with other diseases or related illnesses that causes
damage to the heart, such as atrial ... Show more content on Helpwriting.net ...
The ECG is a test that connects wires to the chest and arms displaying the electrical signals of the
heart on a monitor. In atrial fibrillation, the monitor will display no discernable, independent P
waves, but rather replaced by evident F waves. The QRS complex will vary with R–R intervals and
result in a rapid, narrow complex (Goralnick, 2015). The ECG can also provide other information
such as presence of bundle–branch block, left ventricle hypertrophy, and prior myocardial infraction
(Floyd, 2016). The holter monitor is a portable ECG that is carried around and records 24 hours or
more of heart activity to later be interrupted by the doctor. The event recorder is again the portable
ECG that is intended to record weeks to months of heart activity and records only if an episode of
atrial fibrillation occurs. The echocardiogram is a noninvasive test that shows a video image of the
heart originated by sound waves. These images can show if there is any structural damage of the
heart. Blood tests are completed to eliminate thyroid issues or other biomarkers in the blood that
could be causing the atrial fibrillation (Mayo Clinical Staff, 2015). Positive biomarker results are
elevated C–reactive protein and B–type natriuretic peptide

Atrial Fibrillation: Arrhythmia
Atrial fibrillation is a type of heart rhythm disorder called an 'arrhythmia'. Atrial fibrillation is a
condition that occurs when there is a fault in the electric activity in the heart muscle, causing the
heart to beat irregularly and in an uncoordinated way.
The heart is divided into four chambers. The top two chambers are the atria and the bottom two
chambers are the ventricles. Two of the chambers, together make up the right heart and pump blood
to your lungs, where it picks up oxygen. Blood that is carrying oxygen then travels to the two
chambers on the left side of your heart, which then pumps the blood to the rest of your body. The
ventricles (the bottom chambers) are powerful pumping chambers, which push the blood out of the
heart when they contract. The smaller and less powerful top chambers of the heart (the atria), help to
fill the ventricles with blood for the next contraction. The regulation and coordinated pumping
action of the heart is provided by a network of electrical connections, which deliver electrical
signals to the heart ... Show more content on Helpwriting.net ...
Instead of just the sinus node firing, other parts of the atria begin to send electrical signals.
However, these signals are not as regular as coordinated as the signals from the sinus node and this
leads to the atria (top chambers of the heart) not contracting properly and the ventricles (bottom
chambers of the heart) beating irregularly. Depending on how many electric impulses reach the
ventricles, the heart beat could be slow or fast, but it tends to be very fast in atrial fibrillation. For
example, in a person without atrial fibrillation at rest, the normal sinus node generates
approximately 60 to 90 beats per minute. In a person with atrial fibrillation, the atria generate about
600 impulses per minute, but usually only 80 to 120 of them will reach the ventricles and will make
it

Bridging: Subtherapeutic Anticoagulation Therapy
Bridging refers to the process where thromboembolic risk is reduced by decreasing the time of
subtherapeutic anticoagulation. The most popularly known method is the use of short–term blood
thinners, such as enoxaparin, when anticoagulation therapy (warfarin) is interrupted for surgeries or
other procedures. The desired results of this process is to reduce blood clot development risk but
carries the possible consequence of increasing serious bleeding. According to the ACC/AHA 2014
guidelines, in perioperative management, bridging is recommended for patients with atrial
fibrillation and a mechanical heart valve when the procedure requires interruption of the warfarin
therapy. However, if a patient has atrial fibrillation but no mechanical heart ... Show more content
on Helpwriting.net ...
Since the BRIDGE trial, there has been a decrease in the number of bridging procedures in the low–
to–moderate risk patients with atrial fibrillation. To reiterate, patients with non–mechanical heart
valve atrial fibrillation with low bleed risk procedures and have a lower CHADS2/CHA2DS2–Vasc
score are less likely to need bridging, than those with high risk procedures and
CHADS2/CHA2DS2–Vasc scores. However, risk vs. benefit in using bridging in atrial fibrillation
should always be

The Possibly Detrimental Effects of Cardiac Arrhythmia
Cardiac arrhythmia is defined as, "a condition in which the heart's normal rhythm is disrupted"
(Scholarpedia). A heart usually beats anywhere from 60 to 100 times a minute. If there is a palpation
or a fluttering rarely, the person should usually be fine. If these occur more often or on a frequent
manner, this cardiac arrhythmia could be very severe (Hopkinsmedicine). The hearts electrical
system is what controls the speed and pace of the heartbeat (NHLBI,NIH). Sinoatrial node or SA
node is located in the right atrium and controls the rhythm of the heart. The SA node is cardiac
muscle cells, and it acts as a pacemaker. Sinus rhythm is the regular heart rhythm (Scholarpedia).
Atrial tachycardia is when the heart beats too fast. On the other hand, bradycardia is when the heart
beats too slowly. The heart can also beat irregularly (Hopkinsmedicine). The electrical signal goes
from the SA node to the left and right atria. This allows the atria to pump and contract blood to the
ventricles. Then, the signal goes to the atrioventricular or AV node. The electrical signal slows down
here, so the ventricles have time to fill themselves with blood. After the AV node, the electrical
signal goes to the bundle of His, where the signal is eventually transported to the ventricles. In this
phase, the signal causes the ventricles to contract and pump blood to the lungs and the other parts of
the body (NHLBI, NIH). The reason I described this whole process was for the reader to

Mental And Social Aspects Of Kevin Who Is Diagnosed With...
This essay examines the physical, mental and social aspects of Kevin who is diagnosed with Atrial
Fibrillation (AF) and a known case of transient ischaemic attack(TIA). Atrial flutter or AF is an
arrhythmia which lead to severe cardiac complications. TIA is a nervous system deficit which
occurs as a result of impaired blood flow and usually settle down within 24 hours hence it is a short
term episode. Kevin who is a farmer, lives on his own, needs a thorough understanding of his
present situation and how it can adversely affect his daily activities. However, it is apparent that he
does not understand the seriousness of the situation well enough and at the same time he has a
careless attitude. So it is very important to provide a general ... Show more content on
Helpwriting.net ...
In most cases, atrial fibrillation can end up in a larger left atria and pulmonary veins. Subsequently,
structural and functional changes happens within the heart in terms of size and shape which is called
cardiac remodelling. The initial phase is very important as that is when the the lost stabilities are
restored. Thereafter, if the action still goes on, massive changes happens in heart chambers, cardiac
function gets worse and eventually cardiac failure emerges. IN addition to all the above,
thromboembolism can be simply said as the clot formation in blood vessels which breaks and
obstructs another blood vessel. A thrombus can appear either in veins or in arteries. If it is not
treated properly by anticoagulants, stroke is the end result. Stroke can be categorized into three:
ischaemic, haemorrhagic and TIA or mini stroke. In ischemic stroke, blood circulation to the brain is
deteriorated followed by an obstruction in the blood vessel whereas haemorrhagic stroke is a result
of bleeding in the brain followed by the breakage of blood vessels. Age and cardio vascular
disorders especially hypercoagulable states are the precipitating factors for the former whereas high
blood pressure and aneurysms are the factors for latter. Mostly, TIA occur as a result of narrowing of
vessels. If it is not treated by anticoagulants at the very beginning, there is a high risk of developing
stroke by means of more occlusion in the blood vessel or the rupture. So,

Fibrillation Patient Case Study
Nursing Management of an Atrial Fibrillation Patient With Peptic Ulcer Mr. C.J. is a married 68–
year–old African American man who presents to the emergency department with a chief complaint
(CC) of emesis of bright red blood. The patient reported that he was shopping when he began
throwing up blood at the store. He denied any associated shortness of breath, melena, hematochezia,
liver disease, or prior episodes. The patient appears pale, diaphoretic, and he reported some
lightheadedness with standing and epigastric pain. On further questioning, he stated that he was
admitted in the hospital approximately one month ago with heart palpitation and dizziness and was
diagnosed with Atrial fibrillation. Subsequently, he was discharged home with a prescription of 5
mg of Coumadin daily and Tikosyn following a successful cardioversion. Mr. C.J. was also advised
to monitor his INR ... Show more content on Helpwriting.net ...
Some patients can be asymptomatic, many experience a wide variety of symptoms as a consequence
of the hemodynamic dysfunction (Grossman & Porth, 2014). The people with AF who exhibits no
symptoms often diagnose their condition with a physical examination and an EKG. The common
symptoms that the patient's with AF experience include; palpitations (sensation of chest racing or a
flip–flopping in the chest), weakness, decreased ability to exercise, fatigue, lightheadedness, and
dizziness, while symptoms related to congestive heart failure including dyspnea and angina can
develop in more severe cases (CDC, 2015). Finally, a few will experience the thromboembolic
phenomenon as a consequence of blood flow stasis within the atrium, endothelial dysfunction, and
hypercoagulability (Virchow's triad). The dislodgement of a clot from the atrium resulting in an
embolus to the brain (transient ischemic attach or stroke) or to the mesenteric circulation (bowel
ischemia) can have severe consequences and require immediate

The Human Body System Is Not Immune For Pathological...
Our body system is not immune to pathological deficiencies. There exist numerous identified
pathologies which compromise the regular functioning of a heart, but all heart–related pathologies
are narrowed to a single condition known as Acute Coronary Syndrome (ACS). This is the term
formally used in reference to the different identified clinical entities threatening the cardiovascular
system. ACS is the result of the progressive or complete sudden blocking of the arteries or veins;
this prevents an appropriate blood flow through the circulatory system, and as a consequence, the
body is unable to receive enough oxygen and nutrients to meet its daily necessities.
This makes ACS a life–threatening form of coronary heart disease (CHD) that ... Show more content
on Helpwriting.net ...
In a hospital setting, anticoagulants and antiplatelets are widely prescribed by physicians because of
their greater benefits in changing the physiological homeostasis of the cardiovascular system.
Anticoagulants and antiplatelets play a fundamental role in the treatment of cardiovascular diseases
as they are very effective at counteracting the different symptoms cardiovascular diseases present.
Today, suggested treatments depend on patients' health and type of ACS condition. Such treatments
range from invasive surgery for high risk patients to prescribed medications for low risk patients.
The medications vary in function and purpose. For example, thrombosis is the fast forming of an
abnormal blood clot in an artery or vein. Therefore, it must be treated with a fast acting
anticoagulant which could be Heparin or Fondaparinux (Hyers, 2005). Atrial fibrillation is an
abnormal heartbeat and is frequently treated with another type of anticoagulant, Warfarin. Finally,
unstable angina is a chest discomfort caused by the lack of blood flow through the heart and in most
cases is treated with the most common antiplatelet medication, Aspirin.
Anticoagulants are given to prevent blood from clotting or prevent an existing clot from more
growing. In contrast, antiplatelets are only given to prevent blood from clotting. Beside the
advantages each treatment gives patients, none treatment

Atrial Fibrillation: A Case Study
Karl Popper and Declan Butler's Perspectives Relating to Usage of Anticoagulants
Atrial Fibrillation, a heart condition that causes irregular beating, can result in blood clots. A
possible treatment seemed to be through anticoagulation, which would thin the blood and decrease
the likelihood of blood clots. "Bad medicine: Atrial fibrillation", published in the British Medical
Journal, discusses how medicine can become reactive rather than proactive as it states, "if the
anticoagulation numbers are wrong then we risk the slow growing of a perfect storm of
overtreatment, iatrogenic harm, and bad medicine"(Spence). A serious risk factor for taking an
anticoagulant would be difficulty stopping and slowing down bleeding. Minor injuries such as falls
or cuts could be deadly to a patient on an anticoagulant. Losses of lives, such as David Barker's,
could have been prevented if the approach to treatment would have focused on fixing the irregular
beating rather than chance of blood clots, which only tries to alleviate a side effect of the condition.
Through Popper's perspective on the elements of precise support of theories and Butler's ideas on
how to improve research, we can understand why ... Show more content on Helpwriting.net ...
Popper states that "it is easy to obtain confirmations. for nearly every theory if we look for
confirmations" (Popper 36). Although we know support of anticoagulation use was ill advised, some
elements of the theory were confirmed correct. By looking for confirmations in the theory, the use
of anticoagulants had the support it needed to spread. Since evidence shows that anticoagulants
prevent blood clots it confirms the theory; but the issue is that one cannot support the use of a
treatment for a condition because of a single observation on a side effect. Popper's theory was
illustrated as a single confirmation for a theory caused

Literature Review On Atrial Fibrillation
Atrial fibrillation is a common chronic condition, occurring in approximately three million people in
the United States (American College of Cardiology, 2015). It can lead to serious complications such
as blood clots, stroke, or heart failure (American College of Cardiology, 2015). Therefore,
healthcare providers must understand how to manage new onset and chronic atrial fibrillation.
Patients may present to the emergency department with atrial fibrillation with rapid ventricular
response in both new onset and chronic cases. There are different choices of treatment for atrial
fibrillation with rapid ventricular response. For instance, healthcare providers can choose a rate
controlling medication such as metoprolol or diltiazem. Or they ... Show more content on
Helpwriting.net ...
This article is current because it was published just last year. Links provided in the works cited
pages are functional. Since the research article directly addresses the PICO question, it is relevant.
The researchers have authority since many of them have written additional research articles.
Cogitating that other references have supported the claims made by the authors, this article is
accurate (Gettysburg College, 2016)
The main limitation of this study was the design. Researchers were unable to randomize the groups.
Furthermore, they were unable to detect subgroups (Hines et. al., 2016). They didn't get to directly
interview patients. Another limitation was the setting of the study because it is a teaching hospital.
Finally, the researchers were unable to demonstrate the length of research because they only used
two snapshots of information.
The major conclusion of this study was that there is no difference in effectiveness between
metoprolol and diltiazem. However, researchers found that healthcare providers were more apt to
choose medications found in patient's

Essay On Atrial Fibrillation
Atrial Fibrillation and Prevalence
Atrial Fibrillation (AF) is a common condition causing cardiac rhythm disturbance due to structural
or electro–physical abnormality resulting in abnormal impulse formation [1]. In 2010, the
prevalence of AF in United States (US) was 2.7 to 6.1 million and is expected to rise to between 5.6
and 12 million in 2050 [2]. Approximately 70% of patients with AF are aged between 65–85 years
[3]. AF can be caused by ischemic heart disease, heart failure, hypertension while other causes of
AF may include hyperthyroidism, acute infection, alcohol withdrawal, or post–surgery. Symptoms
manifested in AF may include palpitation, dizziness, sweating, and shortness of breath [4]. AF is
one of the major risk factors of ischemic stroke increasing the risk up to 5–fold and accounts for
one–third of all hospitalizations for ... Show more content on Helpwriting.net ...
Although clinical guidelines recommend use of NOACs for anticoagulation, utilization of
dabigatran and rivaroxaban remains sub–optimal. Adherence to the medication therapy is crucial to
improve efficacy, reduce cost and hospitalizations. Since the NOAC therapy is relatively new, it is
not yet widely accepted and prescribed as warfarin by clinicians and healthcare providers.
Not many studies have examined the medication adherence of NOACs and its patterns over time.
This observation study captured medication adherence (NOACs vs warfarin) and its trend using
PDC over a time period of 12 months in a real world setting. Furthermore, short and long term
predictors of adherence to NOAC therapy were evaluated. The results obtained from the study will
help clinicians and healthcare providers to better understand the use of these drugs in a real world
setting and help implement therapy in practice to provide optimal benefits to the

Atrial Fibrillation Case Study
Introduction:
This case study discusses the management of a 68 year old male who presented with chest
palpitations secondary to rapid atrial fibrillation. Atrial fibrillation is a common cardiac arrhythmia
with serious complications if not treated correctly. This essay will discuss the initial clinical
presentation of the patient and examine the management and outcome of the interventions applied.
The significance of atrial fibrillation including its pathophysiology and aetiology will also be
discussed.
Description of the case:
A 68 year old male presented to the emergency department at 0800 hours via ambulance after
experiencing chest discomfort and intermittent palpitations since 0500 hours. Prior to presentation,
the patient stated he ... Show more content on Helpwriting.net ...
Medical involvement included pharmacological intervention. An infusion of Sotalol 40mg was
administered intravenously at approx 0930 over thirty minutes with continuous cardiac monitoring.
Sotalol, an antiarrhythmic drug, depresses the sinus heart rate, decreases atrioventricular
conduction, decreases cardiac output and decreases systolic and diastolic blood pressure (Bryant,
Knights, & Salerno, 2003). As the patient was already hemodynamically compromised, a bolus
of fluid (Gelofusion 500mls) was administered prior to the Sotalol infusion. The aim was to increase
the circulating volume and raise blood pressure. Vital signs remained stable during the infusion,
however the heart rate was neither converted to sinus rhythm or reduced to a normal rate.
At 1130 a second antiarrhythmic drug, Amiodarone 150mg, was administered via intravenous
infusion. Its action is unknown however is thought to prolong the action potential duration
(Siddoway, 2003). Similar to the Sotolol no effect was noted with the rate or rhythm. The patients
blood pressure remained low, 96/67 and heart rate fluctuating between 100–130 beats per minute.
The patient was asymptomatic with his blood pressure but remained sweaty and lethargic. He
received further intravenous fluids whilst the medical officer discussed his presentation with the
cardiology team.
After discussion with the patient

Atrial Fibrillation Report
Atrial fibrillation is a common disorder associated with significant morbidity, mortality, and
economic costs. Radio–frequency catheter ablation (RFCA) of the distal pulmonary veins and
posterior left atrium is increasingly being used by cardiac interventional electrophysiologists to treat
patients with atrial fibrillation. The success of RFCA is highly dependent on a preprocedural
understanding of the complex three–dimensional (3D) anatomy of the distal pulmonary veins and
posterior left atrium. Neither fluoroscopy nor echocardiography can adequately depict this anatomy.
Earlier reports have shown that 3D gadolinium–enhanced magnetic resonance (MR) angiography
can successfully demonstrate left atrial and distal pulmonary venous anatomy (1–4); however, many
atrial fibrillation patients have pacemakers or defibrillators and cannot undergo MR angiography.
Initially, we developed a 3D multi–detector row computed tomographic (CT) technique to image the
left atrium and pulmonary veins in patients with atrial fibrillation who were to undergo RFCA and
who had pacemakers or defibrillators (5). Subsequently, over an approximately 3–year period, we
evaluated the pulmonary venous and left atrial anatomy in 50 patients without atrial fibrillation and
in over 100 patients with atrial fibrillation prior to their undergoing RFCA. In the vast majority of
cases, we used 3D multi–detector row CT, reserving MR ... Show more content on Helpwriting.net
...
In this article, we review atrial fibrillation and its association with the pulmonary veins; briefly
describe RFCA in atrial fibrillation patients, including possible complications and the need for pre–
RFCA imaging; review left atrial and distal pulmonary venous embryologic development; present
anatomic definitions pertinent to pre–RFCA atrial fibrillation patients; describe the 3D multi–
detector row CT scanning and postprocessing techniques used to evaluate these patients; and discuss
and illustrate some common anatomic variants of the left atrium and pulmonary

Atrial Fibrillation : A Common Problem
ABSTRACT
Atrial fibrillation is a common problem, with over 2 million people affected in the United States.
Atrial fibrillation causes substantial morbidity and mortality, with an increased risk of ischemic
stroke. Thus, it is important to recognize the risk factors associated with the disease to prevent it
from occurring. In this review, being overweight and obese is positively correlated with increased
risk of developing atrial fibrillation in both men and women. This review suggests that the excess
risk of atrial fibrillation associated with obesity may be caused by the left atrial remodeling and
enlargement caused by the excess adipose tissue, hemodynamic overload, and adipokines
inflammatory response. This data raises the possibility that interventions to promote normal weight
may reduce the burden of atrial fibrillation in the current and future population. A few of the
recognized risk factors for atrial fibrillation are male sex, increasing age, hypertension, diabetes,
ischemic heart disease, heart failure, and heart valve disease (13). It has been known for more than
75 years that a critical mass of atrial tissue is necessary for atrial fibrillation to occur and left atrial
enlargement is also an important precursor of atrial fibrillation (3). Several studies have shown that
BMI is one of the most powerful determinants of the left atrial size needed for developing atrial
fibrillation (3), so getting BMI lowered by exercise and a good diet should be of high priority

Atrial Fibrillation Case Summary
Watchman Left Atrial Appendage Closure Device for Embolic Protection in patients with Atrial
Fibrillation (PROTECT AF) was a randomized, unblinded, multicenter trial conducted at 59
hospitals.a It involved 707 patients who were ≥18 years old with NVAF, had one or more CHADS2
risk factors (age >75 years, hypertension, diabetes, heart failure or left ventricle systolic
dysfunction, prior transient ischemic attack or stroke), and were eligible for long–term
anticoagulation with warfarin. Exclusion criteria included presence of patent foramen ovale with
atrial septal aneurysm, atrial septal defect, mechanical valve prosthesis, left ventricular ejection
fraction 97.5% (the non–inferior margin was a rate ratio [RR] of 2.0 comparing event rates between
treatment groups). Superiority was defined by a probability ≥95%.
The primary endpoint was a composite efficacy endpoint including stroke, systemic embolization
(SE), and cardiovascular/unexplained death, analyzed by intention to treat. ... Show more content on
Helpwriting.net ...
It was concluded at this point that closure of the LAA with the Watchman device was non–inferior
to warfarin therapy in regard to prevention of stroke, SE, and cardiovascular death, but the device
group did sustain an increased number of procedure–related safety events, mainly pericardial
tamponade and procedure–related

An EKG would be the first test completed on Mrs. Lee; evaluating her cardiac rhythm and rate. The
symptoms described by Mrs. Lee suggests atrial fibrillation. To determine atrial fibrillation via EKG
we would be looking for an irregular rhythm, a very fast rate, absent p–waves, an absent PR interval
and an either normal or widened QRS (Heart and Stroke, 2017).
Continuous cardiac monitoring remains the gold standard for arrhythmia detection, we would keep
Mrs. Lee on continuous monitoring to provide complete uninterrupted arrhythmia monitoring of her
rate and rhythm (Andrade et al,2015).
Mrs. Lee will require blood work. Cardiac enzymes will be drawn, including a troponin and a
creatine kinase. All cardiac patients should have biomarkers

Atrial Fibrillation
Other hemodynamic effects have also been reported with usage of ivabradine. In a study by
Kurtoglu et al, ivabradine was seen to improve heart rate variability in non–ischemic patients with
heart failure. (26). De Luca et al showed that addition of ivabradine to optimal medical therapy in
patients with stable heart failure with preserved ejection fraction with New York Heart Association
(NYHA) class II, left ventricular ejection fraction (LVEF) > 50% and heart rate > 70 bpm,
significantly improved physical performance by increasing exercise capacity (27). Another study in
patients with stable ischemic heart failure, NYHA functional class II and LVEF ≤ 40%, confirmed
these findings and additionally showed an improved gas exchange (with improvement ... Show more
Another study by Dedkov et al demonstrated that mice with STEMI when treated with Ivabradine
had improved ejection fraction, coronary reserve and the amount of interstitial and periarteriolar
collagen indicating that this agent might be useful in preventing remodeling of heart (46). A pilot
study of 124 patients investigating the role of Ivabradine in successfully reperfused STEMI patients
demonstrated promising results with a smaller increase in LV end–diastolic volume index (p=0.04),
and significant improvement in LV ejection fraction compared with the control group (p=0.04)

Atrial fibrillation is the most common type of heart arrhythmia and often called AFib or AF. It is
defined as the irregular rhythm of the heartbeat. During AFib, the heart can beat too fast or too slow.
This irregular heartbeat can lead to stroke or other heart–related complications.
The heart is controlled by an electrical system of the heart. This electrical system (Figure 1.1) of the
heart includes several functions which hold the contraction of the heart muscles. The SA node starts
the heartbeat by contracting the upper two chambers of the heart known as atria. This electrical
impulse travels through bundle bunches and Purkinje fibers. This pathway of electrical impulse
contracts the lower chamber of the heart called as ventricles. From ... Show more content on
Helpwriting.net ...
Paroxysmal atrial fibrillation occurs sometimes and then stops by itself. In this type of atrial
fibrillation, the abnormal electrical signals of heart and rapid heartbeat begin suddenly and they last
for less than 24 hours. This type of atrial fibrillation is a result of extreme stress.
Persistent atrial fibrillation usually lasts longer than a week and sometimes it doesn't stop by itself.
During this type of AF, heart rate changes may change from slow to fast and back again in small
period of time. Medications or low–voltage electrical shock called cardioversion is used to cure the
persistent atrial fibrillation.
In Permanent or chronic AFib, normal heart rhythm can't be restored with any kind of treatment.
This type of atrial fibrillation needs long–term medication to regulate the heart rate and reduce the
chances of heart stroke. Paroxysmal and Persistent AF are more frequent and over time results in
permanent atrial fibrillation. [7]
The major cause of atrial fibrillation is an excessive amount of alcohol, being overweight and
consumption of illegal drugs such as amphetamines or cocaine.
1.2 Catheter

Atrial Fibrillation
The heart is a complex yet delicate organ that operates the body on a regular basis. Without the heart
the circulation system within the body would cease to exist; therefore, we would cease to exist. As
with everything that is complex and works around the clock there are certain issues that can arise for
example, atrial fibrillation. Atrial fibrillation is the result of an irregular or fast heartbeat this will
often cause an inadequate circulation throughout the rest of the body. The atrium of the heart will
not sync up to the ventricles causing an irregular or fast heartbeat.
The episodes of atrial fibrillation can come and go or remain permanently and cannot usually be
corrected without surgical intervention. This could be caused by hypertension, ... Show more
His work led to the evolution of radiofrequency energy catheters, which use radiofrequency energy
to heat the catheter tip and perform a more precise ablation than what was possible with direct
current ablation. (UCSF.(2012). When cardiac ablation is performed the surgeon is targeting the
diseased conductive tissue once this is done, this will assist in correcting atrial fibrillation within the
heart. These surgeries can be either minimally invasive or require an open surgical approach.
Cardiac ablation is achieved through a cardiac catheter this delivers radiofrequency energy or
cryoenergy to the defective area this is considered to be a minimally invasive approach. The
electrophysiologist will insert a catheter into the femoral vein/artery and threads it to the right or left
atrium and ventricle. They will then test different areas of the heart to try and reproduce
dysrhythmia upon doing this they will then ablate the area of the heart where the disturbance takes
place. Another alternative would be an open surgery known as a sternotomy approach this is where a
midline incision is made in the sternum of the chest. Cannulation of the superior and inferior vena
cava will then take place for a cardiopulmonary bypass. The surgeon will occlude the ascending
aorta and infuse cardioplegic solution into the coronary arteries. Once this is done a right and left
atriotomy is performed and the targets are ablated. The atriotomies are closed, the aorta is
unclamped, cardiopulmonary bypass is stopped, cannulas are removed, chest tubes will be inserted
at this time and the surgical wound is closed. Upon completion of the surgery the patient is taken to
the PACU and monitored for heart rhythm issues as well as, bleeding, infection, or any other
complications from the procedure. ( Fuller, J. (2013).(p.922). There are

Atrial fibrillation is the most frequent cardiac arrhythmia. There has always associated risk of clot
formation and embolization that can lead to ischemic stroke. A large number of these ischemic
events could be prevented by timely anticoagulation. Warfarin has been used for decades for this
purpose, but there are many problems for the patients due to warfarin therapy like there is
continuous need of INR monitoring, many food and drug interactions of the drug, late onset of
action and risk of major bleeding. Anticoagulation with the Novel oral anticoagulants e.g.
Dabigatran, rivaroxaban, apixaban, endoxaban led to similar or even lower rates of ischemic stroke
and major bleeding compared to an adjusted dose of warfarin (INR 2–3) in patients ... Show more
For decades, Warfarin has remained the anticoagulant of choice for the prevention of cardiac
thromboembolic disease in atrial fibrillation patients and in the treatment of deep vein thrombosis
and pulmonary embolism. VKAs are clinically effective as an antithrombotic agent in Atrial
Fibrillation, as dose adjusted warfarin has been proven to cut the risk of stroke by 64% (95% CI,
49%–74%) and all–cause death rate by 26% (95% CI, 3%–43%) [2]. In order to attain optimal
anticoagulation effect of warfarin, frequent plasma level monitoring of International Normalized
Ratio (INR) is required to maintain it in therapeutic range (INR 2–3) but maintaining the INR in
therapeutic range is challenging and for many patients is achieved only approximately 55% of the
time [3]. Thus, this finding counteracts the potential benefits of warfarin and increases its risks. A
combination of factors like an inconvenience for patients and clinicians to use warfarin, large
variability in plasma level of the drug affected by ethnicity and genetic polymorphism [4,5],
interactions with various foods and drugs and the potential for serious hemorrhage e.g. Intracranial
bleeding, have limited the widespread use of warfarin as an effective anticoagulant in nonvalvular
atrial fibrillation (NVAF) [6]. Keeping in mind these facts about

Bridging Trial Case Study

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