ATRIAL FIBRILLATION

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atrialfibrillation

disorganized, rapid, and irregular atrial activation; ventricular response is also irregular

afib etiologies

(reversible) acute hyperthyroidism, an acute vagotonic episode, or acute alcohol intoxication (holiday heart)

symptoms

dizziness, palpitations, syncope, fatigue, exercise intolerance

complication

thromboembolism-->stroke

diagnosis

ECG: irregularly irregular R-R interval, absence of P waves, NARROW QRS complex

acute

new onset, lasts < 48hr

paroxysmal

recurrent, last <48 hr, spontaneously converts to sinus rhythm

persistent

lasts >1 wk, requires conversion to normal sinus rhythm

permanent

can't be converted to sinus rhythm, usu due to atrial remodeling

rate control

β-Blockers, verapamil, diltiazem, Digoxin, amiodarone

rhythm control

prior to conversion, control ventricular rate*
Synchronized cardioversion or pharmacological

>48hr duration treatment

anticoagulation > 3 wk before conversion & at least 4 wk after cardioversion

risk factors

thromboemolism, age ≥ 75 years, HTN, DM, heart failure, prior stroke or TIA, rheumatic heart disease (especially mitral stenosis) or mechanical heart valve

Who is treated with aspirin as opposed to coumadin/warfarin?

patients with no risk factors for thromboembolism or those with contraindications to oral anticoagulation.

Afib + WIDE QRS complex may indicate______ therefore DO NOT use _________ because they may cause ______ which may be______.

wolff-parkinson-white syndrome; AV node blocking drugs (CCB, beta blockers); ventricular fibrillation; fatal

How do you treat patients who do not respond to or cannot take rate-controlling drugs?

radiofrequency ablation of the AV node to cause complete heart block; insertion of a permanent pacemaker is then necessary

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