Atrial fibrillation (AF) is the most common cardiac arrhythmia and increases in prevalence with age. It is characterized by uncoordinated atrial activation and deterioration of atrial function. There are different types of AF based on duration and frequency. The mechanisms involve enhanced automaticity or reentry in pulmonary veins or atria. Management involves rate control, rhythm control, and thromboembolism prevention depending on individual factors like age and symptoms. Treatment includes medications, cardioversion, ablation, and anticoagulation.
A comprehensive approach to Atrial Fibrillation. Everything you need to know about Atrial fibrillation. Including recent 2014 AHA guidelines of management.
A comprehensive approach to Atrial Fibrillation. Everything you need to know about Atrial fibrillation. Including recent 2014 AHA guidelines of management.
Introduction to afib, Epidemiology of afib, etiology of afib, Clinical presentation of people with afib, Investigation and management
AF related outcomes and complications and differential Diagnosis
The following powerpoint presentation is about the current AF guidelines, prepared by Dr Jawad Siraj, who is a final year resident as Cardiology Unit, PGMI, LRH, Peshawar
LECTURE ON ATRIAL FIBRILLATION TO 9TH TERM MEDICAL STUDENTS REFERENCES: DAVIDSON(2018) HARRISON 20TH ED OF MEDICINE AND 2020 EUROPEAN HEART GUIDELINES ON AF
Atrial Fibrillation is the most common arrhythmia encountered by a physician. The global prevalence is increasing because of aging population and better detection methods. Prediction of new onset AF is possible. AF is also a lifestyle disease. Lifestyle therapy, rate or rhythm control and stroke risk stratification are are four main pillars of AF management.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Introduction to afib, Epidemiology of afib, etiology of afib, Clinical presentation of people with afib, Investigation and management
AF related outcomes and complications and differential Diagnosis
The following powerpoint presentation is about the current AF guidelines, prepared by Dr Jawad Siraj, who is a final year resident as Cardiology Unit, PGMI, LRH, Peshawar
LECTURE ON ATRIAL FIBRILLATION TO 9TH TERM MEDICAL STUDENTS REFERENCES: DAVIDSON(2018) HARRISON 20TH ED OF MEDICINE AND 2020 EUROPEAN HEART GUIDELINES ON AF
Atrial Fibrillation is the most common arrhythmia encountered by a physician. The global prevalence is increasing because of aging population and better detection methods. Prediction of new onset AF is possible. AF is also a lifestyle disease. Lifestyle therapy, rate or rhythm control and stroke risk stratification are are four main pillars of AF management.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
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Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
2. Atrial Fibrillation (AF)
Most common sustained cardiac
arrythmia.
Present in 1% persons > 60 yrs of age.
Incidence and prevalence increases with
age.
Framingam data shows life time risk of
AF > 40 yrs of age 26%
3. Definition
• It is a supraventricular tachyarrhythmia characterized
by uncordinated atrial activation with consequent
deterioration of atrial mechanical function.
Types of AF
• Recurrent AF > Two episodes
Paroxysmal AF Resolve spontaneously
Persistent AF Sustained > 7 days.
Permanent AF 1 yr duration.
Lone AF Young individual (<60 yrs of age)
without clinical or echo evidence of cardiopulmonary
disease, including hypertension.
4. Mechanism
• 2 Mechanisms:
• enhanced automaticity in 1 or more
rapidly depolarizing foci
• reentry in 1 or more circuits
• Foci in superior pulmonary veins, RA,
SVC coronary sinus
5.
6. Causes of AF
Associated with organic heart disease
Coronary Heart disease
Hypertension
Valvular Heart disease
Cardiomyopathies
ASD
Chronic CHF
WPW
Myocarditis
7. Causes of AF
With normal hearts
Physiologic Stress
Pericarditis
Chest trauma
Thoracic / Cardiac surgery
Pulmonary disease
Medications
Thyrotoxicosis
Alcohol intake
Fluid / Electrolyte imbalance
Lone AF
9. ECG Manifestations
Small irregular baseline
undulations of variable
amplitude and morphology
called ’f’ wave.
Atrial rate
@ 350-600 bpm.
P waves absent.
Ventricular
Rhythm–Irregularly
irregular.
Rate - 100-160 bpm
10.
11.
12. Bad outcomes?
• Loss of synchronous mechanical activity
• Irregular ventricular response
• Rapid heart rate
• Decreased hemodynamic function
• Tachycardia-induced atrial cardiomyopathy
• Dilated ventricular cardiomyopathy (>130 bpm)
• Thomboembolism
13. Evaluation
• History
• Symptom : Shortness of breath, palpitation,
chest pain, fatigue (elderly)
• Underlying heart disease, hyperthyroidism,
alcohol consumption
• Blood test: Thyroid, renal and hepatic function.
For a first episode of AF when Ventricular rate is
difficult to control
14. • ECG:
• Rhythm
• LVH
• Preexcitation
• BBB
• Prior MI
• TTE
• Valvular heart disease, LA, RA size, LV
size and function, LVH, LA thrombus
(TEE)
17. Initial approach depend on each individual
• Rate control in older with persistent AF
with hypertension or heart disease
• Rhythm control In younger i.e.
paroxysmal lone AF
• 1st choice drug
• 2nd choice left atrial ablation (preferred
in young patients with highly
symptomatic AF).
• Patient for coronary bypass or wall surgery
COX maze III procedure (left atrial ablation)
is preferred.
18. Rate control
1. General rule
Asymptomatic patient with AF : rate control is sufficient (donot
require rhythm control)
Symptomatic Lessil Persistent or
(Hypotension permanent AF
Angina I.V. drugs to slow
Heart failure) ventricular rate blocker
Non DHP CCB
DC conversion No pre Accessory Digoxin (If HF or LVD)
excitation pathway +
I.V. blocker I.V. amiodarone
I.V. Non DHP's I.V. Digoxin
Drug ineffective Ablation of AVN or Accessory path
19. RHYTHM CONTROL
As a rule
• Pt. without structural heart disease IC (Propafenone and
flecainide) 1st line for maintenance
• Pt. with structural heart disease Amidaroine, sotalol
Symptomatic AF with preexcitation
hypotension (Very rapid tachycardia
Anigna, HF Hemodynamic instability
Ongoing myocardialischemia
DC-cardioversion DC cardioversion
20. PHARMACOLOGICAL CARDIOVERSION
• More effective within 7 days of AF
• Flecanide, dofetilide, propafenone, amiodarone
• Digoxin and sotalol not recommended
Selected patients with no
• SAN or AVN disease
• BBB
• QT prolongation
• Brugaa syndrome
• Structural heart disease
Propafenone (600 mg),
flecanide (200-300 mg)
(pill in pocket)
21. Maintenance of sinus rhythm
• Treat precipitating or reversible cause
• Sotalol : In out patients with sinus
rhythm with little or no heart disease.
22. Prevention of thromboembolism
• ACC/AHA guidelines recommend antithrombotic
therapy for all patients with AF. Except
• Lone AF
• Contraindication to antithrombotics
• AF > 48 hours or duration unknown
anticoagulation (INR 2-3) is recommended for at least 3
weeks prior to and 4 weeks after cardioversion,
regardless of the method (electrical or pharmacological)
• AF < 48 hrs emergency cardioversion should be
performed immediately without prior anticoagulation
23. Choice of therapy depends on patient's risk of
stroke and bleeding
Vitamin K antagonist Aspirin (81-325 mg OD)
> 1 risk factor In low risk patients
(> 65 yr, HTN, HF,
LVD, DM, CAD) Contraindication to anticoagulant
(> 75 yr, ICH)
24. Catheter ablation
• Pulmonary veins are an important source of ectopic beats,
initiating frequent paroxysms of AF and triggers as well as
circuits for spontaneous AF, can be the target of therapy.
• Focal PV isolation; linear ablation of right atrium, left atrium
or biatrial; circumferential PV ablation, and segmental PV
ablation.
Surgical ablation
• Maze cut and sew techniques.
• Bipolar radioferquency, cryoablation and microwave energy
have been used as alternatives to the cut-and sew technique.
25. Newly discovered AF
Paroxysmal Persistent
No therapy needed unless Accept permanent AF Rate control and
significant symptoms anticoagulation
(e.g., hypotension, HF, as needed
angina pectoris)
Anticoagulation as needed Anticoagulation Consider
and rate control anti-arrhythmic
as needed drug therapy
Cardioversion
Long-term anti-arrhythmic
drug therapy unnecessary
26. Recurrent Permanent AF
persistent AF
Anticoagulation and
rate control as needed
Minimal or Disabling
no symptoms symptoms in AF
Anticoagulation and Anticoagulation
Rate control as needed and rate control
AAD therapy
Electrical Continue anticoagulation
cardioversion as needed and therapy to
As needed maintain sinus rhythm
Consider ablation for severely
symptomatic recurrent AF after
failure of greater than or equal to 1
AAD plus rate control
