ATRIAL FIBRILATION

DEVIKHA PEREMEL

ATRIAL FIBRILATION
Atrial fibrillation(AF)is a disorder
of the rhythm of theheart. It results
from disorganised electrical activity
in theatriaof the heart,
whichcauses rapid stimulation of
theventricles,leading to an irregular
pulse rate.

EPIDERMIOLOGY
Atrial fibrillation is the most common
arrhythmia & the incidence & prevalence
increases with the age
The incidence:
<0.5% below 50Yrs
2% in age 60-69
4.6% in age 70-79
8.8% in age 80-89
Men were 1.5 times more likely to develop AF than
women
Whites were more likely to develop AF than blacks

 If left untreated, AF can lead to various short- and long-term

problems. In patients who have pre-existingheart failure, the
rapid heart rate seen in AF can lead to low blood pressure,lung
congestion,angina, or worsening of the heart failure.
Untreated AF also increases the risk ofstroke. This is because in
AF the atriabecomedilated and contract ineffectively, which
leads to blood clots developing in the atria. These clots can
subsequently dislodge and travel to the brain and other organs,
causing strokes and other organ damage.
The main risk factors for developing a stroke in patients
with AF are:
Prior stroke ortransient ischaemic attack
The finding of left ventricular dysfunction onechocardiogram
Age > 65
High blood pressure
Rheumatic heart disease
Diabetes mellitus
Congestive heart failure

HOW TO DIAGNOSE AF?

History & physical examination:
- Symptoms: severity, duration, constant or paroxysmal
- Predisposing factors: alcohol, emotional
or exercise
- Disease association: CVS, DM, HTN,
hyperthyroidism
- Evaluate heart sound (murmur), thyroid or evidence of
heart failure or AF complications (stroke).
Electrocardiogram (ECG)
Echocardiogram - to evaluate the size of the right & left
atria and ventricles, and to asses peak right ventricle
pressure
Transesophageal Echocardiography more sensitive for
identifying thombus in the left atrium or left atrial
appendage.

MANAGEMENT OF AF

ATRIAL FLUTTER

DEFINITION
Atrial flutter(AFL) is anabnormal heart
rhythmthat occurs in theatriaof theheart.
When it first occurs, it is usually associated
with tachycardia(beats over 100 per minute)
and falls into the category ofsupra-ventricular
tachycardias.
While this rhythm occurs most often in
individuals with cardiovascular disease
(e.g.hypertension,coronary artery disease,
andcardiomyopathy) and diabetes, it may
occur spontaneously in people with otherwise
normal hearts.
It is typically not a stable rhythm, and

CLINICAL FEATURES
Atrial flutter can sometimes go unnoticed.
SYMPTOMS:
Sensations of regularpalpitations. Such sensations
usually last until the episode resolves, or until the
heart rate is controlled.
shortness of breath,
chest pains,
light-headedness or dizziness,
nausea and, in some patients, and
nervousness

 Prolonged fast flutter may lead to decompensation

with loss of normal heart function (heart failure). This
may manifest as effort intolerance (exertional
breathlessness), nocturnal breathlessness, or swelling
of the legs or abdomen.
SIGNS:
Pulse may be irregular or regular, but is usually rapid.
RAISED in the jugular venous pulse.
May be associated with signs of underlying causes eg, thyrotoxicosis, alcoholism, pericarditis, valvular
dysfunction or septal heart defects.
Heart failure, hypotension and respiratory distress
may be present.

DIFFERENTIAL DIAGNOSIS
Supraventricular tachyarrhythmias.
Atrial fibrillation.
Wolff-Parkinson-White syndrome.

INVESTIGATIONS
Electrocardiogram:
The absence of P waves, the P waves are replaced by F
waves of flutter, between which are no isoelectric intervals.
F waves have a frequency of 250-350 beats / minute, are
monomorphic, regular and have the appearance of saw
tooth.
QRS complex has a normal aspect, it may have a longer
duration than usual, if there is a branch block or a
ventricular preexcitation syndrome.
In the absence of atrioventricular accessory pathways,
driving trough ventricles is the most common, with block 2 /
1 ( can be met atrioventricular block 3 / 1 or 4 / 1).
QRS complexes occur at irregular intervals, and F waves are
well evidenced in the ECG.

MANAGEMENT
General treatment goals for symptomatic atrial
flutter are similar to those for atrial fibrillation
and include the following:
Control of the ventricular rate
Restoration of sinus rhythm
Prevention of recurrent episodes or reduction
of their frequency or duration
Prevention of thromboembolic complications
Minimization of adverse effects from therapy

 Cardioversion (DC)is currently recommended in forms of atrial

flutter with hemodynamic deterioration or in combination with
Wolf-Parkinson-White syndrome. After sedation, is applied an
external electric shock, synchronous with low energy (20-50
joules), which can be repeated if necessary. Anticoagulant
therapy should be considered in case of atrial flutter with a
length greater than 48 hours.
Decrease of ventricular rate with atrioventricular blockers:
verapamil, diltiazem, digoxin, esmolol. Sometimes digoxin can
converse a atrial flutter into a atrial fibrillation.
Cardiac Ablation - High frequency (>500,000 Hz) energy flows
easily up the ablation catheter because it has a very low
resistance. When this energy flow encounters human tissue,
the higher impedance produces resistive heat which pushes the
cellular temperature above 50 degrees celsius and kills the
cells. The dead tissue no longer propagates electrical signals,
and the irregular rhythm patterns are disrupted. RF ablation is
an effective treatment for supraventricular tachycardia (SVT)
and atrioventricular nodal reentry tachycardia (AVNRT).

THANK YOU!!