Atrial fibrillation resident survival guide: Difference between revisions
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== Definition== | == Definition== |
Revision as of 19:28, 15 August 2013
Conduction | ||
Sinus rhythm | Atrial fibrillation |
File:Critical Pathways.gif |
Atrial Fibrillation Microchapters | |
Special Groups | |
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Diagnosis | |
Treatment | |
Cardioversion | |
Anticoagulation | |
Surgery | |
Case Studies | |
Atrial fibrillation resident survival guide On the Web | |
Directions to Hospitals Treating Atrial fibrillation resident survival guide | |
Risk calculators and risk factors for Atrial fibrillation resident survival guide | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Hilda Mahmoudi M.D., M.P.H.[2]
Definition
Atrial fibrillation (AF or Afib) is a cardiac arrhythmia (abnormal heart rhythm) that involves the two upper chambers (atria) of the heart.
Causes
Life Threatening Causes
Life-threatening conditions which may result in death or permanent disability within 24 hours if left untreated.
- Atrial ischemia
- Congestive heart failure
- Coronary artery disease
- Dehydration
- Electrolyte disturbance
- Endocarditis
- Heart failure
- Hypertensive heart disease[1],[2]
- Hypothermia
- Hypoxia
- Myocardial infarction[3]
- Myocarditis
- Pericarditis
- Pheochromocytoma
- Pulmonary embolism[4]
- Renal insufficiency
- Subarachnoid hemorrhage
- Unstable angina
- Uremic pericarditis
Common Causes
Management
Figure 1: Pharmacological management of patients with newly discovered atrial fibrillation:[5]
Newly discovered AF | |||||||||||||||||||||||||||||||||||||
Paroxysmal | Persistent | ||||||||||||||||||||||||||||||||||||
No therapy needed unless severe symptoms (e.g., hypotension, HF, angina pectoris | Accept permanent AF | Rate control and anticoagulation as needed | |||||||||||||||||||||||||||||||||||
Anticoagulation as needed | Anticoagulaion and rate control* as needed | Consider antiarrhythmic drug therapy | |||||||||||||||||||||||||||||||||||
Cardioversion | |||||||||||||||||||||||||||||||||||||
Long term antiarrhythmic drug therapy unnecessary | |||||||||||||||||||||||||||||||||||||
ADD indicates antiarrhythmic drugs
*See figure 5
Figure 2: Pharmacological management of patients with recurrent paroxysmal atrial fibrillation:[5]
Recurrent paroxysmal AF | |||||||||||||||||||||||||||||||||
Minimal or no symptoms | Disabling symptoms in AF | ||||||||||||||||||||||||||||||||
Anticoagulation and rate control as needed | Anticoagulation and rate control as needed | ||||||||||||||||||||||||||||||||
No drug for prevention of AF | Antiarrhythmic drug therapy* | ||||||||||||||||||||||||||||||||
AF ablation if ADD treatment fails | |||||||||||||||||||||||||||||||||
ADD indicates antiarrhythmic drugs
*See figure 5
Figure 3: Pharmacological management of patients with recurrent persistent atrial fibrillation:[5]
Recurrent persistent AF | |||||||||||||||||||||||||||||||||
Minimal or no symptoms | Disabling symptoms in AF | ||||||||||||||||||||||||||||||||
Anticoagulation and rate control as needed | Anticoagulation and rate control | ||||||||||||||||||||||||||||||||
Antiarrhythmic drug therapy* | |||||||||||||||||||||||||||||||||
Electrical cardioversion as needed | |||||||||||||||||||||||||||||||||
Continue anticoagulation as needed and therapy to maintain sinus rhythm* | |||||||||||||||||||||||||||||||||
Consider ablation for severely symptomatic recurrent AF after failure of greater than or equal to 1 ADD plus rate control | |||||||||||||||||||||||||||||||||
ADD indicates antiarrhythmic drugs
*See figure 5. Initiate drug therapy before cardioversion to reduce the likelihood of early recurrence of AF.
Figure 4: Pharmacological management of patients with permanent atrial fibrillation:[5]
Permanent AF | |||||||||||||||||||||||||||||||
Anticoagulation and rate control* as needed | |||||||||||||||||||||||||||||||
*See figure 5
Figure 5: Antiarrhythmic drug therapy for maintain sinus rhythm in patients with recurrent paroxysmal or persistent atrial fibrillation:[5]
Drugs are listed alphabetically and not in order of suggested use.
The seriousness of heart disease progresses from left to right, and selection of therapy in patients with multiple conditions depends on the most serious condition present.
LVH indicates left ventricular hypertrophy.
References
- ↑ Krahn, AD.; Manfreda, J.; Tate, RB.; Mathewson, FA.; Cuddy, TE. (1995). "The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study". Am J Med. 98 (5): 476–84. doi:10.1016/S0002-9343(99)80348-9. PMID 7733127. Unknown parameter
|month=
ignored (help) - ↑ Kannel, WB.; Abbott, RD.; Savage, DD.; McNamara, PM. (1982). "Epidemiologic features of chronic atrial fibrillation: the Framingham study". N Engl J Med. 306 (17): 1018–22. doi:10.1056/NEJM198204293061703. PMID 7062992. Unknown parameter
|month=
ignored (help) - ↑ Zimetbaum, PJ.; Josephson, ME.; McDonald, MJ.; McClennen, S.; Korley, V.; Ho, KK.; Papageorgiou, P.; Cohen, DJ. (2000). "Incidence and predictors of myocardial infarction among patients with atrial fibrillation". J Am Coll Cardiol. 36 (4): 1223–7. PMID 11028474. Unknown parameter
|month=
ignored (help) - ↑ Goldhaber, SZ.; Visani, L.; De Rosa, M. (1999). "Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER)". Lancet. 353 (9162): 1386–9. PMID 10227218. Unknown parameter
|month=
ignored (help) - ↑ 5.0 5.1 5.2 5.3 5.4 Fuster, V.; Rydén, LE.; Cannom, DS.; Crijns, HJ.; Curtis, AB.; Ellenbogen, KA.; Halperin, JL.; Kay, GN.; Le Huezey, JY. (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. Unknown parameter
|month=
ignored (help)