Atrial fibrillation hyperthyroidism

Jump to navigation Jump to search


Resident
Survival
Guide
File:Critical Pathways.gif

Sinus rhythm
Atrial fibrillation

Atrial Fibrillation Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Atrial Fibrillation from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Special Groups

Postoperative AF
Acute Myocardial Infarction
Wolff-Parkinson-White Preexcitation Syndrome
Hypertrophic Cardiomyopathy
Hyperthyroidism
Pulmonary Diseases
Pregnancy
ACS and/or PCI or valve intervention
Heart failure

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

EKG Examples
A-Fib with LBBB

Chest X Ray

Echocardiography

Holter Monitoring and Exercise Stress Testing

Cardiac MRI

Treatment

Rate and Rhythm Control

Cardioversion

Overview
Electrical Cardioversion
Pharmacological Cardioversion

Anticoagulation

Overview
Warfarin
Converting from or to Warfarin
Converting from or to Parenteral Anticoagulants
Dabigatran

Maintenance of Sinus Rhythm

Surgery

Catheter Ablation
AV Nodal Ablation
Surgical Ablation
Cardiac Surgery

Specific Patient Groups

Primary Prevention

Secondary Prevention

Supportive Trial Data

Cost-Effectiveness of Therapy

Case Studies

Case #1

Atrial fibrillation hyperthyroidism On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Atrial fibrillation hyperthyroidism

CDC on Atrial fibrillation hyperthyroidism

Atrial fibrillation hyperthyroidism in the news

Blogs on Atrial fibrillation hyperthyroidism

Directions to Hospitals Treating Atrial fibrillation hyperthyroidism

Risk calculators and risk factors for Atrial fibrillation hyperthyroidism

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Anahita Deylamsalehi, M.D.[3] Varun Kumar, M.B.B.S.

Overview

Atrial fibrillation occurs in 10% to 25% of patients with hyperthyroidism, nevertheless only 1% of patients with new onset atrial fibrillation detected to have hyperthyroidism. Elevation of thyroid hormones in hyperthyroidism is responsible for chronotropic and dromotropic effects on heart. Mechanisms such as increase in left ventricular mass in addition to impaired ventricular relaxation which lead to elevation of left atrial pressure , Heart rate elevation and subsequent ischemia and atrial ectopic activity are proposed as possible explaination for increased risk of atrial fibrillation in hyperthyroid patients. Atrial fibrillation in the setting of thyrotoxicosis has been shown to be associated with decompensated heart failure and a significant increase in morbidity and mortality rate. Up to two-thirds of patients will reach sinus rhythm with appropriate treatment and control of hyperthyroidism.

Atrial Fibrillation and Hyperthyroidism

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)[11]

Class I
"1. Beta blockers are recommended to control ventricular rate in patients with atrial fibrillation complicating thyrotoxicosis unless contraindicated. (Level of Evidence: C)"
"2. In circumstances in which a beta blocker cannot be used, a nondihydropyridine calcium antagonist is recommended to control the ventricular rate. (Level of Evidence: C)"


2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)[12]

Hyperthyroidism (DO NOT EDIT) [12]

Class I
"1. Administration of a beta blocker is recommended to control the rate of ventricular response in patients with atrial fibrillation complicating thyrotoxicosis, unless contraindicated. (Level of Evidence: B)"
"2. In circumstances when a beta blocker cannot be used, administration of a nondihydropyridine calcium channel antagonist (diltiazem or verapamil) is recommended to control the ventricular rate in patients with atrial fibrillation and thyrotoxicosis. (Level of Evidence: B)"
"3. In patients with atrial fibrillation associated with thyrotoxicosis, oral anticoagulation (INR 2.0 to 3.0) is recommended to prevent thromboembolism, as recommended for atrial fibrillation patients with other risk factors for stroke. (Level of Evidence: C)"
"4. Once a euthyroid state is restored, recommendations for antithrombotic prophylaxis are the same as for patients without hyperthyroidism. (Level of Evidence: C)"

Sources

References

  1. 1.0 1.1 Clozel JP, Danchin N, Genton P, Thomas JL, Cherrier F (1984) Effects of propranolol and of verapamil on heart rate and blood pressure in hyperthyroidism. Clin Pharmacol Ther 36 (1):64-9. PMID: 6734051
  2. 2.0 2.1 2.2 2.3 2.4 2.5 Bielecka-Dabrowa A, Mikhailidis DP, Rysz J, Banach M (2009). "The mechanisms of atrial fibrillation in hyperthyroidism". Thyroid Res. 2 (1): 4. doi:10.1186/1756-6614-2-4. PMC 2680813. PMID 19341475.
  3. Krahn AD, Klein GJ, Kerr CR, Boone J, Sheldon R, Green M; et al. (1996). "How useful is thyroid function testing in patients with recent-onset atrial fibrillation? The Canadian Registry of Atrial Fibrillation Investigators". Arch Intern Med. 156 (19): 2221–4. PMID 8885821.
  4. Frost L, Vestergaard P, Mosekilde L (2004). "Hyperthyroidism and risk of atrial fibrillation or flutter: a population-based study". Arch Intern Med. 164 (15): 1675–8. doi:10.1001/archinte.164.15.1675. PMID 15302638.
  5. Agner T, Almdal T, Thorsteinsson B, Agner E (1984). "A reevaluation of atrial fibrillation in thyrotoxicosis". Dan Med Bull. 31 (2): 157–9. PMID 6723378.
  6. Staffurth JS, Gibberd MC, Fui SN (1977). "Arterial embolism in thyrotoxicosis with atrial fibrillation". Br Med J. 2 (6088): 688–90. doi:10.1136/bmj.2.6088.688. PMC 1631908. PMID 902055.
  7. Robinson K, Frenneaux MP, Stockins B, Karatasakis G, Poloniecki JD, McKenna WJ (1990) Atrial fibrillation in hypertrophic cardiomyopathy: a longitudinal study. J Am Coll Cardiol 15 (6):1279-85. PMID: 2329232
  8. Russell JW, Biller J, Hajduczok ZD, Jones MP, Kerber RE, Adams HP (1991) Ischemic cerebrovascular complications and risk factors in idiopathic hypertrophic subaortic stenosis. Stroke 22 (9):1143-7. PMID: 1822968
  9. Shigematsu Y, Hamada M, Mukai M, Matsuoka H, Sumimoto T, Hiwada K (1995) Mechanism of atrial fibrillation and increased incidence of thromboembolism in patients with hypertrophic cardiomyopathy. Jpn Circ J 59 (6):329-36. PMID: 7666571
  10. Hirsh J (1991) Oral anticoagulant drugs. N Engl J Med 324 (26):1865-75. DOI:10.1056/NEJM199106273242606 PMID: 1801769
  11. January, C. T.; Wann, L. S.; Alpert, J. S.; Calkins, H.; Cleveland, J. C.; Cigarroa, J. E.; Conti, J. B.; Ellinor, P. T.; Ezekowitz, M. D.; Field, M. E.; Murray, K. T.; Sacco, R. L.; Stevenson, W. G.; Tchou, P. J.; Tracy, C. M.; Yancy, C. W. (2014). "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society". Circulation. doi:10.1161/CIR.0000000000000041. ISSN 0009-7322.
  12. 12.0 12.1 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA; et al. (2011). "2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". J Am Coll Cardiol. 57 (11): e101–98. doi:10.1016/j.jacc.2010.09.013. PMID 21392637.
  13. Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114 (7):e257-354. DOI:10.1161/CIRCULATIONAHA.106.177292 PMID: 16908781
  14. Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 123 (10):e269-367. DOI:10.1161/CIR.0b013e318214876d PMID: 21382897
  15. Estes NA, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS et al. (2008) ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Clinical Performance Measures for Atrial Fibrillation): developed in collaboration with the Heart Rhythm Society. Circulation 117 (8):1101-20. DOI:10.1161/CIRCULATIONAHA.107.187192 PMID: 18283199

CME Category::Cardiology