ATRIAL FIBRILLATION

1
ATRIAL FIBRILLATION

• Linda A. Snyder, MSN, CRNP

2
Definition

• A common arrhythmia characterized by chaotic,
  rapid, discontinuous atrial depolarizations
  resulting in rapid oscillations that are recorded
  as irregularly formed f waves in contrast to
  uniform P waves of sinus or other distinct
  supraventricular rhythms. Ventricular responses
  become irregular. Rate may be rapid.

3
Classification

• Paroxysmal
• Persistent
• Permanent or Chronic
• Lone

4
EKG Characteristics

• Rate Atrial rate 400 600 bpm Ventricular
  rate Rapid 110 160 bpm Controlled 60
  100 bpm
• Rhythm Irregular
• P- Waves Not present
• P-R Interval Not measurable

5
(No Transcript)
6
(No Transcript)
7
EKG Characteristics, cont.

• QRS Complex Usually normal
• Conduction Intra-atrial conduction is
  disorganized and irregular. Ventricular
  conduction is usually normal.

8
Conditions Frequently Associated with AF
Age HTN CAD Cardiomyopathy ETOH/Drug Intox. CVA DM Pulm. Embolus COPD Pulm. HTN
Hyperthyroid Valvular Hrt. Disease PVD Inflam/infiltrat. Processes Post Op OHS Metabolic disorders
9
Symptoms

• None
• Palpitations
• Lightheadedness
• SOB
• Diaphoresis
• Anxiety

• Syncope
• Dizziness
• Chest pain / pressure
• Abnormal Sensation in throat / neck
• Frequent urination
• Altered cognition.

10
Implications

• Can lead to decrease in cardiac output
• Danger of thromboemboli

11
Treatment Goals

• Eliminate cause
• Control ventricular rate
• Restore and Maintain Sinus Rhythm
• Prevent Thromboembolism

12
Eliminate Cause

• Post- op
• Electrolyte Imbalance
• Thyroid Function
• Pneumonia

13
Rate Control

• Calcium Channel Blockers
• Beta Blockers
• Digitalis
• A-V Node Ablation and Pacemaker

14
Restoring and Maintaining Sinus Rhythm

• Cardioversion
• Antiarhythmia Drugs
• Ablation Procedures

15
Antiarrhythmia Drugs

• Vaughan Williams Classification
• Issues with tolerability and efficacy
• Toxicity concerns, esp. with Amiodarone
• Some require in-patient stay for initiation

16
Surgical/Ablation Procedures

• Considered when---
• Medical therapy does not effectively control or
  correct AF
• Medications are not tolerated
• Anticoagulants can not be taken
• Symptoms of AF continue, despite medical therapy
• Blood clots, including stroke, occur
• Surgery is needed for coexisting heart condition

17
Goals of Surgical Procedures

• Produce lesions and ultimately scar tissue to
  block the abnormal electrical impulses from being
  conducted through the heart.
• Promote the normal conduction of impulses through
  the proper pathway.

18
Procedures for AF

• Catheter-based Posterior Left Atrial
  Radiofrequency Ablation
• Keyhole Approach
• Maze Procedure
• Modified Maze

19
Alternative Energy Sources

• Radiofrequency
• Cryothermy
• Microwave
• Lasers

20
Preventing Thromboembolism

• COUMADIN
• Aspirin
• Plavix
• New Anticoagulants
• Left Atrial Appendage Occlusive Device

21
(No Transcript)
22
Indications for Hospital Admission with an
Initial Diagnosis of AF

• Significant symptoms
• Hemodynamic intolerance
• High risk for thromboembolic complications
• To facilitate prompt cardioversion
• Concomitant condition that mandates admission
  (i.e. acute MI, acute PE, acute TIA or stroke,
  thyroid storm)

23
(No Transcript)
24
The End

• ?s