Atrial fibrillation is an irregular heartbeat caused by rapid and chaotic electrical activity in the atria. There are three main types - paroxysmal which comes and goes for less than 2 days, persistent for over 7 days and likely to recur, and permanent which cannot be reverted. Causes include hypertension, obesity, heart disease, alcohol, smoking, and other chronic conditions. Symptoms include fatigue, palpitations, dizziness, and chest pain. Diagnosis involves ECG, echocardiogram, Holter monitor and other tests. Treatment options include rate control with medications, rhythm control with antiarrhythmics like amiodarone, cardioversion, catheter ablation, or a pacemaker. A

1. ATRIAL FIBRILLATION

2. What is Atrial Fibrillation?
 Also known as “quivering heart”
 Chaotic ectopic or reentrant activity in atria
 Irregular heartbeat & rhythm
Faster resting heart rate than normal
Atria - contracts randomly or so fast that the
heart cannot rest properly.
Rate- atrial rate( 400-600),
 -venticular, depends on AV node block
 150-200 ,

3. Atrial Fibrillation
Continuous rapid firing of multiple atrial foci or
from multiple areas of reentry
 There is loss of atrial kick – 30% of Cardiac
output

4. Types of Atrial Fibrillation
Paroxysmal Atrial Fibrillation
> an AF which comes and goes, and each episodes
last no more than 2 days
Persistent Atrial Fibrillation
> an AF which is experienced for a period of longer than
seven days and is most likely going to need treatment to
revert the heartbeat back to normal. This type of AF
tends to recur
Permanent Atrial Fibrillation
> An existing long-term AF which cannot be reverted back
to normal

5. Causes of Atrial Fibrillation
> Hypertension
> Obesity
> Complication of certain heart disease (e.g IHD,
heart valve problems and pericardial disease)
> high alcohol and caffeine consumption
> Smoking
> Family history
> Any chronic condition (e.g thyroid problems,
diabetes, asthma, etc.)

6. Signs and Symptoms
•General fatigue
•palpitations
•Rapid and irregular heartbeat
•Fluttering or “thumping” in the chest
•Dizziness
•Shortness of breath and anxiety
•Weakness
•Faintness or confusion
•Fatigue when exercising
•Sweating
•Chest pain or pressure

7. Diagnostic Procedures
> ECG
> Echocardiogram
> Holter and event monitors
- this records the heart’s electrical activity
for a full 24 to 48 hours period

8. Cont…
> Stress test
- the patient will do some
exercise to make the heart work hard and beat
fast while the tests are done.

9. Cont…
> Transesophageal Echocardiography )TEE)
- it is usually recommended before doing
electrical cardioversion, to rule out the presence
of blood clots in the atria.

10. Cont…
> Chest x-ray
> Blood tests (e.g thyroid function test,
electrolytes etc.)

11. Treatment
> Rate control
• beta-blockers
– Esmolol
– Propranolol
– metoprolol
– atenolol)
• calcium channel blockers - diltiazem, verapamil
• digitalis - lanoxin

12. Treatment
Rhythm control Antiarrhythmias
• Amiodarone – mg/min
• It prolongs the duration of action potentials in cardiac
fibers, depresses conduction velocity, slows conduction
and prolongs refractoriness at the AV node, and
exhibits some alpha and beta blockade activity
• Side Effects: Hypotension, pain on IV site
• Over dose: AV block, bradycardia, cardiogenic shock,
hepatotoxicity, hypotension
• Concentration: 1.5mg/ml in D5W

13. Treatment
Elective Cardioversion
• Convert hemodynamically stable AF to NSR
• 3 weeks anticoagulation before cardioversion
– ↓ risk of thromboembolism
• TEE before cardioversion to check atrial
thrombus
• Anticoagulation continued for 4 weeks after
cardioversion - ↓ risk of delayed embolism
• Analgesia & sedation

14. Treatment
Catheter Ablation
• Used if medicines & cardioversion are not
effective
• Wire is inserted through a vein in the leg or
arm and threaded to the heart, radio wave
energy is sent through the wire to destroy
abnormal tissue that may be disrupting the
normal flow of electrical signals

15. Catheter Ablation

16. PACEMAKER
• if the AV node is not
functioning properly

17. Blood clot or stroke prevention
- anticoagulants are recommended such as
warfarin, dabigatran, heparin and aspirin

18. Nursing Interventions
All nursing interventions are based upon the problems and
symptoms that the patient has:
> Plan for frequent rest periods
> Encourage patient to talk about their feelings and concerns
regarding their condition
> Monitor for any signs and symptoms of embolism and
bleeding
> Monitor vital signs while the patient is @ rest and after
physical activity
> Monitor intake and output and patient’s weight
> Health teaching about their diagnosis, treatment, and
lifestyle changes such as healthy diet, reducing stress, quitting
smoking, etc.