Atrial fibrillation differential diagnosis: Difference between revisions
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| | |Superimposed on or buried within the QRS complex | ||
| | |Absent (P wave can appear after the QRS complex and before the T wave, and in atypical AVNRT, the P wave can appear just before the QRS complex) | ||
| | |Less than 0.12 seconds, consistent, and normal in morphology in the absence of aberrant conduction, QRS alternans may be present | ||
| | |May break with adenosine or vagal maneuvers | ||
| | |60%-70% of all SVTs | ||
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|Multifocal Atrial Tachycardia | |Multifocal Atrial Tachycardia | ||
|Irregular | |||
|Atrial rate is > 100 beats per minute | |||
|Varying morphology from at least three different foci, absence of one dominant atrial pacemaker, can be mistaken for atrial fibrillation if the P waves are of low amplitude | |||
|Variable PR intervals, RR intervals, and PP intervals | |||
|Less than 0.12 seconds, consistent, and normal in morphology | |||
|Does not terminate with adenosine or vagal maneuvers | |||
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| | |High incidence in the elderly and in those with COPD | ||
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|Paroxysmal Supraventricular Tachycardia | |Paroxysmal Supraventricular Tachycardia | ||
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|Wolff-Parkinson-White Syndrome | |Wolff-Parkinson-White Syndrome | ||
| | |Regular | ||
| | |Atrial rate is nearly 300 bpm and ventricular rate is at 150 bpm | ||
| | |With orthodromic conduction due to a bypass tract, the P wave generally follows the QRS complex, whereas in AVNRT, the P wave is generally buried in the QRS complex. | ||
| | |Less than 0.12 seconds | ||
| | |A delta wave and evidence of ventricular pre-excitation if there is conduction to the ventricle via ante-grade conduction down an accessory pathway. It should be noted, however, that in some patients with WPW, a delta wave and pre-excitation may not be present because bypass tracts do not conduct ante-grade. | ||
| | |May break in response to procainamide, adenosine, vagal maneuvers | ||
| | |Worldwide prevalence of WPW syndrome is 100 - 300 per 100,000 | ||
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Revision as of 15:32, 15 November 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Atrial fibrillation must be distinguished from other common atrial arrhythmias, which include atrial flutter, atrial tachycardia, paroxysmal supraventricular tachycardia, Wolff-Parkinson-White syndrome, and atrioventricular nodal reentry tachycardia.
Differentiating Atrial Fibrillation from other Diseases
Atrial fibrillation has to be differnetiated from other diseases like:
- Atrial flutter
- Atrial tachycardia
- Atrioventricular nodal reentry tachycardia (AVNRT)
- Multifocal atrial tachycardia
- Paroxysmal supraventricular tachycardia
- Wolff-Parkinson-White syndrome
The differentiating features are largely based on both EKG findings and cardiovascular examination.
- Atrial fibrillation is irregularly irregular, while the other rhythms such as atrial flutter, sinus tachycardia, AV nodal reentry tachycardia and paroxysmal supraventricular tachycardia are all much more regular.
- An atrioventricular nodal reentry tachycardia will often break with either carotid sinus massage or AV nodal blocking agents.
- If the patient has Wolff-Parkinson-White syndrome there may be much more rapid conduction. The presence of the delta wave on EKG is characteristic.
Arrhythmia | Rhythm | Rate | P wave | PR Interval | QRS Complex | Response to Maneuvers | Epidemiology | Co-existing Conditions |
---|---|---|---|---|---|---|---|---|
Atrial Fibrillation | Irregularly irregular | Absent, fibrillatory waves | Absent | Less than 0.12 seconds, consistent, and normal in morphology in the absence of aberrant conduction | Does not break with adenosine or vagal maneuvers | Old age, following bypass surgery, in mitral valve disease, hyperthyroidism | ||
Atrial Flutter | 75 (4:1 block), 100 (3:1 block) and 150 (2:1 block) bpm, but 150 is more common | Sawtooth pattern of P waves at 250 to 350 beats per minute | Varies depending upon the magnitude of the block, but is short | Less than 0.12 seconds, consistent, and normal in morphology | Conduction may vary in response to drugs and maneuvers dropping the rate from 150 to 100 or to 75 bpm | More common in the elderly, after alcohol | ||
Atrioventricular nodal reentry tachycardia (AVNRT) | Superimposed on or buried within the QRS complex | Absent (P wave can appear after the QRS complex and before the T wave, and in atypical AVNRT, the P wave can appear just before the QRS complex) | Less than 0.12 seconds, consistent, and normal in morphology in the absence of aberrant conduction, QRS alternans may be present | May break with adenosine or vagal maneuvers | 60%-70% of all SVTs | |||
Multifocal Atrial Tachycardia | Irregular | Atrial rate is > 100 beats per minute | Varying morphology from at least three different foci, absence of one dominant atrial pacemaker, can be mistaken for atrial fibrillation if the P waves are of low amplitude | Variable PR intervals, RR intervals, and PP intervals | Less than 0.12 seconds, consistent, and normal in morphology | Does not terminate with adenosine or vagal maneuvers | High incidence in the elderly and in those with COPD | |
Paroxysmal Supraventricular Tachycardia | ||||||||
Wolff-Parkinson-White Syndrome | Regular | Atrial rate is nearly 300 bpm and ventricular rate is at 150 bpm | With orthodromic conduction due to a bypass tract, the P wave generally follows the QRS complex, whereas in AVNRT, the P wave is generally buried in the QRS complex. | Less than 0.12 seconds | A delta wave and evidence of ventricular pre-excitation if there is conduction to the ventricle via ante-grade conduction down an accessory pathway. It should be noted, however, that in some patients with WPW, a delta wave and pre-excitation may not be present because bypass tracts do not conduct ante-grade. | May break in response to procainamide, adenosine, vagal maneuvers | Worldwide prevalence of WPW syndrome is 100 - 300 per 100,000 | |
Ventricular Fibrillation | ||||||||
Ventricular Tacycardia |