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

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

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)

24. “The End” ?’s