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ATRIAL FIBRILLATION

ATRIAL FIBRILLATION. Linda A. Snyder, MSN, CRNP. Definition:.

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ATRIAL FIBRILLATION

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  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

  5. EKG Characteristics, cont. • QRS Complex: Usually normal • Conduction: Intra-atrial conduction is disorganized and irregular. Ventricular conduction is usually normal.

  6. Conditions Frequently Associated with AF

  7. None Palpitations Lightheadedness SOB Diaphoresis Anxiety Syncope Dizziness Chest pain / pressure Abnormal Sensation in throat / neck Frequent urination Altered cognition. Symptoms

  8. Implications • Can lead to decrease in cardiac output • Danger of thromboemboli

  9. Treatment Goals • Eliminate cause • Control ventricular rate • Restore and Maintain Sinus Rhythm • Prevent Thromboembolism

  10. Eliminate Cause • Post- op • Electrolyte Imbalance • Thyroid Function • Pneumonia

  11. Rate Control • Calcium Channel Blockers • Beta Blockers • Digitalis • A-V Node Ablation and Pacemaker

  12. Restoring and Maintaining Sinus Rhythm • Cardioversion • Antiarhythmia Drugs • Ablation Procedures

  13. Antiarrhythmia Drugs • Vaughan Williams Classification • Issues with tolerability and efficacy • Toxicity concerns, esp. with Amiodarone • Some require in-patient stay for initiation

  14. 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

  15. 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.

  16. Procedures for AF • Catheter-based Posterior Left Atrial Radiofrequency Ablation • Keyhole Approach • Maze Procedure • Modified Maze

  17. Alternative Energy Sources • Radiofrequency • Cryothermy • Microwave • Lasers

  18. Preventing Thromboembolism • *** COUMADIN *** • Aspirin • Plavix • New Anticoagulants • Left Atrial Appendage Occlusive Device

  19. Indications for HospitalAdmission 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)

  20. “The End” ?’s

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