https://www.youtube.com/watch?v=wxJuP-i9Jx0

Introduction

• Most common sustained cardiac arrhythmia
• Very common
  • 5% of patients over 70-75 years and 10% of 80-85 years
• Some may have symptoms but most important is to manage the risk of stroke

Aetiology

• Is an irregularly irregular arrhythmia of supraventricular origin
  • Therefore, when AF is >100bpm, it can be classified as a supraventricular tachycardia
    • Commonly called ‘fast AF’
      • But should really be called ‘AF with rapid ventricular response’, as it is the ventricles that are in tachycardia, not the atrial fibrillation
    • Should be treated as per the ALS tachyarrhythmia algorithm

Types of AF

• Can be classified:

  1. First detected episode (irrespective of whether it is symptomatic or self-terminating)

  2. Recurrent episodes, when a patient has 2 or more episodes of AF.

     • If episodes of AF terminate spontaneously then the term paroxysmal AF is used
       • Such episodes last less than 7 days (typically < 24 hours).
     • If the arrhythmia is not self-terminating then the term persistent AF is used. Such episodes usually last greater than 7 days

  3. Permanent AF there is continuous atrial fibrillation which cannot be cardioverted or if attempts to do so are deemed inappropriate.

  • Treatment goals are therefore rate control and anticoagulation if appropriate

Signs and Symptoms

• Symptoms
  • Palpitations
  • Dyspnoea
  • Chest pain or discomfort
  • Syncope/dizziness
• Signs
  • Irregularly irregular pulse
  • Stroke or a TIA

Investigations

• ECG is essential
  • Other pathologies can also give an irregular pulse
    • Such as ventricular ectopics or sinus arrhythmia
• ECG features
• Perform a transthoracic echocardiography (TTE) in those with AF:
  • If suspecting HF
  • If you are considering rhythm control with cardioversion

Management I

Management is dependant on many factors:

• Acuity of onset
• Associated symptoms
• Heamodynamic status
• Duration of the dysrhythmia (<48 h or >48 h).

There are two key parts of the managing patients wit AF:

• Rate/Rhythm control
• Reducing stroke risk