ATRIAL FIBRILLATION

What is Atrial Fibrillation?Also known as “quivering heart”Chaotic ectopic or reentrant activity in atria Irregular heartbeat & rhythmFaster resting heart rate than normalAtria - contracts randomly or so fast that the heart

cannot rest properly.Rate- atrial rate( 400-600), -venticular, depends on AV node block 150-200 ,

Atrial FibrillationContinuous rapid firing of multiple atrial foci or

from multiple areas of reentry There is loss of atrial kick – 30% of Cardiac

output

Types of Atrial Fibrillation

Paroxysmal Atrial Fibrillation >an AF which comes and goes, and each episodes last no

more than 2 daysPersistent Atrial Fibrillation

>an AF which is experienced for a period of longer than seven days and is most likely going to need treatment to revert the heartbeat back to normal. This type of AF tends to recurPermanent Atrial Fibrillation

>An existing long-term AF which cannot be reverted back to normal

Causes of Atrial Fibrillation

>Hypertension >Obesity

>Complication of certain heart disease (e.g IHD, heart valve problems and pericardial disease)

>high alcohol and caffeine consumption >Smoking

>Family history >Any chronic condition (e.g thyroid problems,

diabetes, asthma, etc.)

Signs and Symptoms

•General fatigue•palpitations

•Rapid and irregular heartbeat•Fluttering or “thumping” in the chest

•Dizziness•Shortness of breath and anxiety

•Weakness•Faintness or confusion•Fatigue when exercising

•Sweating•Chest pain or pressure

Diagnostic Procedures >ECG

>Echocardiogram > Holter and event monitors

- this records the heart’s electrical activity for a full 24 to 48 hours period

Cont… >Stress test

- the patient will do some exercise to make the heart work hard and beat fast while the tests are done.

Cont… TEE)) > Transesophageal Echocardiography

- it is usually recommended before doing electrical cardioversion, to rule out the presence of blood clots in the atria.

Cont… >Chest x-ray

>Blood tests (e.g thyroid function test, electrolytes etc.)

Treatment

>Rate control• beta-blockers– Esmolol– Propranolol– metoprolol – atenolol)

• calcium channel blockers - diltiazem, verapamil• digitalis - lanoxin

Treatment

Rhythm control Antiarrhythmias • Amiodarone – mg/min• It prolongs the duration of action potentials in cardiac

fibers, depresses conduction velocity, slows conduction and prolongs refractoriness at the AV node, and exhibits some alpha and beta blockade activity

• Side Effects: Hypotension, pain on IV site• Over dose: AV block, bradycardia, cardiogenic shock,

hepatotoxicity, hypotension• Concentration: 1.5mg/ml in D5W

Treatment

Elective Cardioversion• Convert hemodynamically stable AF to NSR• 3 weeks anticoagulation before cardioversion

– ↓ risk of thromboembolism• TEE before cardioversion to check atrial

thrombus• Anticoagulation continued for 4 weeks after

cardioversion - ↓ risk of delayed embolism• Analgesia & sedation

Treatment Catheter Ablation• Used if medicines & cardioversion are not

effective• Wire is inserted through a vein in the leg or

arm and threaded to the heart, radio wave energy is sent through the wire to destroy abnormal tissue that may be disrupting the normal flow of electrical signals

Catheter Ablation

PACEMAKER• if the AV node is not

functioning properly

Blood clot or stroke prevention - anticoagulants are recommended such as

warfarin, dabigatran, heparin and aspirin

Nursing Interventions

All nursing interventions are based upon the problems and symptoms that the patient has:

>Plan for frequent rest periods >Encourage patient to talk about their feelings and concerns

regarding their condition >Monitor for any signs and symptoms of embolism and bleeding >Monitor vital signs while the patient is @ rest and after physical

activity >Monitor intake and output and patient’s weight

>Health teaching about their diagnosis, treatment, and lifestyle changes such as healthy diet, reducing stress, quitting smoking, etc.