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Atrial fibrillation
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- 2. OVERVIEW • WHAT ISATRIAL FIBRILLATION? • WHY IT IS IMPORTANT? • PATHOGENESIS • TYPES OF ATRIAL FIBRILLATION • DIAGNOSIS • WORKUP • MANAGEMENT
- 7. ATRIAL FIBRILLATION First describedby 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 FIBRILLATIONIS 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 AFand 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
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- 15. PATTERNS OF ATRIALFIBRILLATION
- 16. TYPES OF ATRIALFIBRILLATION
- 17. SYMPTOMS • Asymptomatic • Symptomatic Decreasedcardiac 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 RHYTHMASSOCIATION symptom class
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- 20. ATRIAL FIBRILLATION ONECG 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/minuteSLOW 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 WITHAPPARENTLY 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- Intrinsiclung pathology 3.ECHO-Valular Heart Disease 4.CAG-Ischemic Heart disease 5.TMT-Exercise induced IHD,AF 6.Holter-Paroxysmal AF
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- 28. 1.RATE AND RHYTHMCONTROL
- 29. 1.RATE AND RHYTHMCONTROL
- 30. 1.RATE AND RHYTHMCONTROL
- 31. 1.RATE AND RHYTHMCONTROL
- 32. 1.RATE AND RHYTHMCONTROL
- 33. 1.RATE AND RHYTHMCONTROL
- 34. 1.RATE AND RHYTHMCONTROL
- 35. 1.RATE AND RHYTHMCONTROL
- 36. 1.RATE AND RHYTHMCONTROL
- 37. 1.RATE AND RHYTHMCONTROL
- 38. 2.MANAGEMENT OF TRIGGERINGCONDITIONS VALVULAR HEART DISEASE WEIGHT REDUCTION
- 39. 2.MANAGEMENT OF TRIGGERINGCONDITIONS RESPIRATORY DISEASES KIDNEY DISEASE
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- 46. 3.ASSESS STROKE RISK-SECONDARYSTROKE PREVENTION
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- 55. SPECIAL SCENARIOS-POST OPERATIVEATRIAL FIBRILLATION
- 56. SPECIAL SCENARIOS-ATRIAL FIBRILLATIONIN PREGNANCY
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