Atrial Fibrillation AF

Question 1

AF

Answer 1

Chaotic and disorganised atrial activity due to lots of re-entry
Reduced diastole due to decreased filling time (decrease CO)
Irregularly irregular
Incidence increases with age

Question 2

Symptoms

Answer 2

Can be asymptomatic
Palpitations
SOB 
Chest pain 
Pre-syncope 
Fatigue 
Sweaty

Question 3

Paroxysmal AF

Answer 3

Lasts less than 48 hours
Spontaneous
Often recurrent

Question 4

Persistent AF

Answer 4

Lasts longer than 48 hours
Cardioverted to restore NSR (by pharmacologic or non pharmacologic methods)
Unlikely to revert to NSR spontaneously

Question 5

Permanent AF

Answer 5

No pharmacological or non-pharmacological methods can restore NSR
Clinical decision made to leave patient in AF and control rate

Question 6

Idiopathic AF

Answer 6

Can’t identify cause of AF

Question 7

Common causes of AF

Answer 7

Hypertension
Valvular heart disease 
Congenital heart disease
Alcohol abuse 
Heart failure 
Familial
Stress

Question 8

ECG findings

Answer 8

Atrial rate >300bpm 
Atria quiver and shimmer but don't properly contract 
Irregular rate 
Absence of P waves
Presence of F waves

Question 9

Management: Rhythm control

Answer 9

Restore the patients to NSR:
Pharmacologic cardioversion - eg: class I, class III agents
Non-pharmacologic cardioversion - eg: DCCV (electrical)

Maintain NSR once restored:
Long term chronic dosing of anti-arrhythmic medication
Catheter ablation or atrial focus or pulmonary veins
Surgery

Question 10

Management: Rate control

Answer 10

Accept that patient has AF but don’t treat it directly
Focus on controlling ventricular rate (HR)
Aim to slow AVN conduction using:
Anti-arrhyhmic drugs - eg: class II, IV agents
Digoxin
Ablate AVN and use a pacemaker

Question 11

Anticoagulation in AF

Answer 11

Important to anti-coagulate at patient is at thrombo-emolic risk 
Anticoagulate in:
valvuar disease 
hypertension
old age 
heart failure
following MI