a summary of atrial fibrillation

1. ATRIAL FIBRILLATION

2. OVERVIEW
• WHAT IS ATRIAL FIBRILLATION?
• WHY IT IS IMPORTANT?
• PATHOGENESIS
• TYPES OF ATRIAL FIBRILLATION
• DIAGNOSIS
• WORKUP
• MANAGEMENT

7. ATRIAL FIBRILLATION
First described by Sir William Harvey in 17th century
observed chaotic motion of atria in open chest animal
ECG findings described in 1909 by Sir Thomas Lewis:
“irregular or fibrillatory waves and irregular ventricular response” or
“absent atrial activity with grossly irregular ventricular response”

8. WHY ATRIAL FIBRILLATION IS IMPORTANT?
• Atrial fibrillation is the most common sustained arrhythmia
• 6% over the age of 65 experience it
• Responsible for 15% strokes
• Atrial fibrillation accounts for
1/3 of all patient discharges
with arrhythmia as
principal diagnosis.
Atrial Fibrillation
34%
Ventricular
Fibrillation
2%
Ventricular
Tachycardia
10%
Conduction
Disease
8%
Sudden Cardiac
death
3%
Sick Sinus
syndrome
9%
Atrial Flutter
4%
VPC's
6%
PSVT
6%
Unspecified
18%
Baily D. J Am Coll Cardiol. 1992;19(3):41A

10. PATHOGENESISPathophysiology of AF and comorbidities
Inflammation?
• Left ventricular hypertrophy
• Diastolic dysfunction
• Mitral regurgitation Atrial stretch
Inflammation?Stretch-activated channels
Dispersion of refractoriness
Pulmonary vein focal/discharges?
Increased vulnerability to AF?
Compliance
• HTN and/or
vascular disease

11. PATHOGENESIS

13. CASUAL ASSOCIATION FACTORS

14. CASUAL ASSOCIATION FACTORS

15. PATTERNS OF ATRIAL FIBRILLATION

16. TYPES OF ATRIAL FIBRILLATION

17. SYMPTOMS
• Asymptomatic
• Symptomatic
Decreased cardiac output Irregular rapid ventricular rate,loss of atrial
contraction,reduced filling of ventricle Palpitations
Dyspnoea
Chest pain
Dizziness, Syncope
Neurological deficits for TIA, stroke
Systemic embolism

18. EUROPEAN HEART RHYTHM ASSOCIATION
symptom class

19. DIAGNOSIS & WORKUP

20. ATRIAL FIBRILLATION ON ECG
1.Lack of discrete P waves.
2.Fibrillatory or f waves at a rate generally between 350 &
600 beats/minute,the f waves vary continuously in amplitude, morphology,
and intervals.
3.Ventricular response follows no repetitive pattern, the variability in the
intervals between QRS complexes is “irregularly irregular.” ventricular rate(in
absence of AV nodal blocking agents or intrinsic conduction disease)ranges
between 90- 170beats/min.
4.The QRS complexes are narrow unless AV conduction through the His
Purkinje system is abnormal due to functional (rate-related) aberration, pre-
existing bundle branch or fascicular block, or ventricular pre excitation with
conduction down the accessory pathway.

21. VENTRICULAR RESPONSE
RATE TERMINOLOGY
<60/minute SLOW VENTRICULAR RESPONSE (SVR)
60-100/minute CONTROLLED VENTRICULAR RESPONSE (CVR)
100-140/minute FAST VENTRICULAR RESPONSE (FVR)
>140/minute RAPID VENTRICULAR RESPONSE (RVR)

23. ATRIAL FIBRILLATION WORSENS
• HOCM
• DIASTOLIC DYSFUNCTION
• DILATED CARDIOMYOPATHY
• MITRAL STENOSIS
• CAD
• CONSTRICTIVE PERICARDITIS

24. ATRIAL FIBRILLATION WITH APPARENTLY REGULAR PULSE
Atrial Fibrillation with complete heart block
Patient on verapamil
on pacemaker
ventricular tachycardia
very fast or very slow ventricular response

25. Investigations
1.Blood Investigations-CBC,RBS,RFT,LFT,TFT
2.CXR- Intrinsic lung pathology
3.ECHO-Valular Heart Disease
4.CAG-Ischemic Heart disease
5.TMT-Exercise induced IHD,AF
6.Holter-Paroxysmal AF

26. MANAGEMENT

27. MANAGEMENT

28. 1.RATE AND RHYTHM CONTROL

29. 1.RATE AND RHYTHM CONTROL

30. 1.RATE AND RHYTHM CONTROL

31. 1.RATE AND RHYTHM CONTROL

32. 1.RATE AND RHYTHM CONTROL

33. 1.RATE AND RHYTHM CONTROL

34. 1.RATE AND RHYTHM CONTROL

35. 1.RATE AND RHYTHM CONTROL

36. 1.RATE AND RHYTHM CONTROL

37. 1.RATE AND RHYTHM CONTROL

38. 2.MANAGEMENT OF TRIGGERING CONDITIONS
VALVULAR HEART DISEASE
WEIGHT REDUCTION

39. 2.MANAGEMENT OF TRIGGERING CONDITIONS
RESPIRATORY DISEASES
KIDNEY DISEASE

40. 3.ASSESS STROKE RISK

41. 3.ASSESS STROKE RISK

42. 3.ASSESS STROKE RISK

43. 3.ASSESS STROKE RISK

44. 3.ASSESS STROKE RISK

45. 3.ASSESS STROKE RISK

46. 3.ASSESS STROKE RISK-SECONDARY STROKE PREVENTION

54. SPECIAL SCENARIOS

55. SPECIAL SCENARIOS-POST OPERATIVE ATRIAL FIBRILLATION

56. SPECIAL SCENARIOS-ATRIAL FIBRILLATION IN PREGNANCY

57. SPECIAL SCENARIOS-CONGENITAL HEART DISEASE