Download ATRIAL FIBRILLATION

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
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•
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•
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
Hyperthyroid
Valvular Hrt.
Disease
PVD
Inflam/infiltrat.
Processes
Post Op OHS
DM
Pulm. Embolus
COPD
Pulm. HTN
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
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Eliminate cause
Control ventricular rate
Restore and Maintain Sinus Rhythm
Prevent Thromboembolism
Eliminate Cause
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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
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•
•
•
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
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•
•
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Radiofrequency
Cryothermy
Microwave
Lasers
Preventing Thromboembolism
•
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*** 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”
?’s