ATRIAL FIBRILLATION

Linda A. Snyder, MSN, CRNP

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.

Classification

• Paroxysmal

• Persistent

• Permanent or Chronic

• Lone

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

EKG Characteristics, cont.

• QRS Complex: Usually normal

• Conduction: Intra-atrial conduction is disorganized and irregular. Ventricular conduction is usually normal.

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

Symptoms

None

Palpitations

Lightheadedness

SOB

Diaphoresis

Anxiety

• Syncope• Dizziness• Chest pain / pressure• Abnormal Sensation in

throat / neck• Frequent urination• Altered cognition.

Implications

• Can lead to decrease in cardiac output

• Danger of thromboemboli

Treatment Goals

• Eliminate cause

• Control ventricular rate

• Restore and Maintain Sinus Rhythm

• Prevent Thromboembolism

Eliminate Cause

• Post- op

• Electrolyte Imbalance

• Thyroid Function

• Pneumonia

Rate Control

• Calcium Channel Blockers

• Beta Blockers

• Digitalis

• A-V Node Ablation and Pacemaker

Restoring and Maintaining Sinus Rhythm

• Cardioversion

• Antiarhythmia Drugs

• Ablation Procedures

Antiarrhythmia Drugs

• Vaughan Williams Classification

• Issues with tolerability and efficacy

• Toxicity concerns, esp. with Amiodarone

• Some require in-patient stay for initiation

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

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.

Procedures for AF

• Catheter-based Posterior Left Atrial Radiofrequency Ablation

• Keyhole Approach

• Maze Procedure

• Modified Maze

Alternative Energy Sources

• Radiofrequency

• Cryothermy

• Microwave

• Lasers

Preventing Thromboembolism

• *** COUMADIN ***

• Aspirin

• Plavix

• New Anticoagulants

• Left Atrial Appendage Occlusive Device

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)

“The End”

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