Atrial fibrillation

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

3. 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”

4. 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. Baily D. J Am Coll Cardiol . 1992;19(3):41A

5. PATHOGENESIS

6. PATHOGENESIS

7. CASUAL ASSOCIATION FACTORS

8. CASUAL ASSOCIATION FACTORS

9. PATTERNS OF ATRIAL FIBRILLATION

10. TYPES OF ATRIAL FIBRILLATION

11. 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

12. EUROPEAN HEART RHYTHM ASSOCIATION symptom class

13. DIAGNOSIS & WORKUP

14. 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.

15. 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)

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

17. 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

18. 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

19. MANAGEMENT

20. MANAGEMENT

21. 1.RATE AND RHYTHM CONTROL

22. 1.RATE AND RHYTHM CONTROL

23. 1.RATE AND RHYTHM CONTROL

24. 1.RATE AND RHYTHM CONTROL

25. 1.RATE AND RHYTHM CONTROL

26. 1.RATE AND RHYTHM CONTROL

27. 1.RATE AND RHYTHM CONTROL

28. 1.RATE AND RHYTHM CONTROL

29. 1.RATE AND RHYTHM CONTROL

30. 1.RATE AND RHYTHM CONTROL

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

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

33. 3.ASSESS STROKE RISK

34. 3.ASSESS STROKE RISK

35. 3.ASSESS STROKE RISK

36. 3.ASSESS STROKE RISK

37. 3.ASSESS STROKE RISK

38. 3.ASSESS STROKE RISK

39. 3.ASSESS STROKE RISK-SECONDARY STROKE PREVENTION

40. SPECIAL SCENARIOS

41. SPECIAL SCENARIOS-POST OPERATIVE ATRIAL FIBRILLATION

42. SPECIAL SCENARIOS-ATRIAL FIBRILLATION IN PREGNANCY

43. SPECIAL SCENARIOS-CONGENITAL HEART DISEASE