Atrial fibrillation

Question 1

What is atrial fibrillation?

Answer 1

Atrial fibrillation is the disorganised electrical activity of the atria resulting in an irregular heartbeat.

Question 2

What is the heart beat rhythm of a patient with AF described as?

Answer 2

irregularly irregular

Question 3

How effective are anti-arrhythmic drugs in AF?

Answer 3

30%

Question 4

What is electrical cardioversion?

Answer 4

Sending a currant through the heart to force it back into sinus rhythm.

Question 5

how effective is electrical cardioversion?

Answer 5

90%

Question 6

What are the 3 forms of AF?

Answer 6

• Paroxysmal (lasting less than 48 hours, often recurrent)
• Persistent (an episode of AF lasting longer than 48 hours)
• Permanent (inability to restore to NSR)

Question 7

What is Lone (idiopathic) AF?

Answer 7

AF with an absence of any heart disease and no evidence of ventricular dysfunction. could be genetic. significant stroke rate if older than 75.

Question 8

What are the symptoms of AF?

Answer 8

• Palpitation
• pre-syncope
• syncope
• chest pain
• dyspnea
• sweatiness
• fatigue
  (can also be asymptomatic)

Question 9

What is absent on the ECG in a patient with AF?

Answer 9

absence of P wave, instead have a ‘F’ wave.

Question 10

What management options are available for AF?

Answer 10

rhythm control or rate control.

anti-coagulation for both if high risk for thromboembolism.

Question 11

What treatment option are there for rate control?

Answer 11

• Digoxin
• Betablockers
• Verapamil, diltiazem

Question 12

What treatment options are there for rhythm control?

Answer 12

• restoration of NSR: pharmacologic cardioversion (anti-arrythmic drugs e.g. amiodarone), direct current cardioversion (DCCV)
• maintenance of NSR: anti-arrhythmic drugs, catheter ablation of atrial focus, surgery (maze procedure)