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Atrial Fibrillation Flashcards

1
Q

What is atrial fibrillation?

A

Where the electrical activity of the atria becomes disorganised, leading to an irregularly irregular pulse

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2
Q

What rate do the atria typically contract at in atrial fibrillation?

A

300-600 beats per minute

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3
Q

What is the classification of AF?

A

Acute - less than 48 hours
Paroxysmal - less than 7 days, intermittent
Persistent - more than 7 days but amenable to cardioversion
Permenant - more than 7 days and not amenable to cardioversion

Fast AF - >100 beats per minute
Slow AF - <100 beats per minute

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4
Q

What are the most common causes of AF?

A

SMITH
S - sepsis
M - mitral valve pathology
I - ischaemic heart disease
T - thyrotoxicosis
H - hypertension

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5
Q

What are the symptoms of AF?

A

Palpitations
Shortness of breath
Chest pain
Lightheadedness
Syncope

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6
Q

What are the two differentials for an irregularly irregular pulse?

A

Atrial fibrillation
Ventricular ectopics

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7
Q

How can you differentiate between ventricular ectopics and atrial fibrillation?

A

Ventricular ectopic beats usually disappear as the heart rate reaches a certain threshold - a regular heart rate during exercise suggests a diagnosis of ventricular ectopics

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8
Q

What investigations are useful in the diagnosis of AF?

A

ECG - required in all patients
Echocardiogram
Bloods to look for reversible causes - FBC, TFT, LFT

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9
Q

What is seen on ECG in patients with AF?

A

Irregularly irregular pulse
Absent P waves
Narrow QRS complex tachycardia

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10
Q

What further investigations are required for paroxysmal AF?

A

24 hour ambulatory ECG
Cardiac event recorder (1-2 weeks)

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11
Q

What is the management of acute AF?

A

Synchronised DC cardioversion +/- amiodarone

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12
Q

What is the first line management of AF in most cases?

A

Rate control

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13
Q

What are the options for rate control in AF?

A

Beta blocker (atenolol or bisoprolol) - first line
Calcium channel blocker (diltiazem or verapamil)
Digoxin

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14
Q

When is rhythm control offered for AF?

A

A reversible cause for AF
New onset AF
Heart failure caused by AF
Symptoms despite being effectively rate controlled

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15
Q

What are the options for rhythm control of AF?

A

Cardioversion
Long term pharmacological treatment

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16
Q

What types of cardioversion are there?

A

Immediate cardioversion
- Pharmacological cardioversion
- Electrical cardioversion

Delayed cardioversion
- Electrical cardioversion is recommended

17
Q

What is electrical cardioversion?

A

A cardiac defibrillator is used to shock the atria back into sinus rhythm - this is done under sedation or anaesthesia

18
Q

What are the requirements for undergoing delayed cardioversion?

A

The patient should be anticoagulated for three weeks prior, or has had a TOE to exclude a mural thrombus

Patients should be rate controlled while waiting for delayed cardioversion

19
Q

What are the treatment options for long term rhythm control?

A

Beta blocker - first line
Dronedarone - second line
Amiodarone - used in patients with heart failure or left ventricular dysfunction

20
Q

What is the management of paroxysmal AF?

A

Flecainade taken when they have symptoms

21
Q

What treatment is used for AF when rate and rhythm control are not adequate?

A

Ablation
- Left atrial ablation
- AV node ablation and pacemaker

22
Q

How does left atrial ablation work?

A

A catheter inserted through the femoral vein punctures through the septum into the left atrium

The catheter identifies the abnormal area of the atria, and this can be ablated

23
Q

How does AV node ablation work?

A

AV node ablation destroys the connection between the atria and the ventricles - the abnormal signals from the atria can no longer be conducted through to the ventricles

A pacemaker is needed to control ventricular contraction

24
Q

When should patients with AF be anticoagulated?

A

Males - Chadsvasc score > 1
Females - Chadvasc score > 2

25
Q

What anticoagulants are used in AF?

A

DOACs (apixaban, edoxaban, rivaroxaban, dabigatran) - first line
Warfarin
LMWH e.g enoxaparin

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