Atrial Fibrillation: Bibek Raj Poudel Intern Pahs-Som
Atrial Fibrillation: Bibek Raj Poudel Intern Pahs-Som
Atrial Fibrillation: Bibek Raj Poudel Intern Pahs-Som
2073/02/03
(2) Re-entry within the atria maintains atrial fibrillation, with multiple
interacting re-entry circuits operating simultaneously
ECG Finding
• Characteristic ‘irregularly irregular’ pulse
• M>F
• AF is a marker for heart disease, the severity of heart
disease, and age, and
– Therefore difficult to determine the extent to which AF itself
contributes to associated increased mortality and morbidity
• AF increases the risk of stroke by 5x and is estimated
to be the cause of 25% of strokes
• Precipitating factors/Etiology
Clinical Type
• Paroxysmal
– Recurrent AF (≥2 episodes) that terminates spontaneously in seven
days or less, usually less than 24 hours
– Up to 90% are asymptomatic
• Persistent
– Fails to self-terminate within 7 days.
– Episodes often require pharmacologic or electrical cardioversion to
restore sinus rhythm
– Progression to persistent and permanent AF occur in >50 percent
beyond 10 years despite antiarrhythmic therapy
– If last > 1year---Long standing persistent
Clinical Type
• Permanent
– individuals with persistent atrial fibrillation where a
decision has been made to no longer pursue a
rhythm control strategy
• Examination
Investigations
• ECG
– Markers of nonelectrical cardiac disease (LVH), Q
wave (coronary artery disease)
– Markers of electrical heart disease (delta wave or
short PR interval) or BBB
– QT interval
• ECHO---Transthoracic----thrombus
Management
• Primarily guided by
– Patients’ symptoms
• Uses
– Symptomatic paroxysmal AF,
– First episode of symptomatic persistent AF,
– AF with difficult rate control,
– AF that has resulted in depressed ventricular function or that
aggravates heart failure
• Up To Date 21.6
Thank You!!!