Atrial Fibrillation/Flutter Flashcards
What is atrial fibrillation?
Chaotic + disorganised atrial activity
–> irregularly irregular heart beat
What causes AF?
Ectopic foci in muscle sleeves in ostia of pulmonary veins
What are the 3 options for termination of AF?
- spontaneous reversion to sinus rhythm
- pharmacological cardioversion
- DCCV
What are the 3 types of AF?
Paroxysmal
Persistent
Permanent (chronic)
How is paroxysmal AF defined?
Acute onset, lasts < 48 hours
Often recurrent
How is persistent AF defined?
An episode lasting > 48 hours which can still be cardioverted to NSR
Unlikely to spontaneously revert to NSR
How is permanent AF defined?
Inability to restore NSR with pharmacological or non-pharmacological methods
What are some of the symptoms of AF?
Palpitations Chest pain Syncope/pre-syncope SOB Sweatiness Fatigue
–> symptoms often worse at the onset of AF
What are the ECG features in AF?
- atrial rate > 300 (atria quiver, not contract)
- irregularly irregular rhythm
- ventricular rate variable
- absent P waves
- presence of ‘f’ waves
Which factors affect the ventricular rate in AF?
- AV node conduction properties
- sympathetic/parasympathetic tone
- presence of drugs acting on the AV node (e.g. beta-blockers, CCBs)
What are the three main approaches to management of AF?
Rhythm control –> maintain SR
Rate control –> accept AF but control ventricular rate
Anticoagulation –> prevent thromboembolism
How does rate control work in AF?
Slows AVN conduction
What are the options for rate control drugs in AF?
Beta-blocker or CCB (Verapamil, diltiazem) first line
Digoxin in patients who live sedentary lifestyle e.g. elderly
What are the options for pharmacological cardioversion in AF?
Amiodarone
Flecainide
What are the options for maintenance of normal SR in AF?
- Beta-blocker
- Flecainide, sotalol or amiodarone
- Catheter ablation of atrial focus
- Surgery –> Maze procedure
How do you assess the need of anticoagulation in AF?
CHA2DS2VASc score
What are the components of the CHA2DS2VASc score?
C - congestive HF/LV dysfunction H - hypertension A2 - age 75 or over D - diabetes S2 - stroke (TIA/TE) V - vascular disease A - age 65-74 S - sex female
Which other factors (outwith the CHA2DS2VASc score) are a strong indication for anticoagulation in AF?
Thyrotoxicosis
Hypertrophic cardiomyopathy
Valvular AF - mitral stenosis/regurgitation
What is the choice of anticoagulant in AF?
Warfarin
- if non-valvular AF, DOAC can be used
What is atrial flutter?
Rapid, regular form of atrial tachycardia
Usually paroxysmal
What is the classic ECG finding in atrial flutter?
Classic ‘saw tooth’ baseline
What is usually the atrial rate in atrial flutter?
300 bpm
What is usually the ventricular rate in atrial flutter?
150 bpm
What are the main treatment options in atrial flutter?
Cardioversion Drugs to: - slow ventricular rate - restore sinus rhythm - maintain sinus rhythm RF ablation Warfarin to prevent thromboembolism
