Atrial Fibrillation

Atrial Fibrillation

1. Clinical Manifestations

   • Symptoms (Jankowska-Polańska, Kaczan, Lomper, Nowakowski, & Dudek, 2018).
     • Psychological distress
       • Those with atrial fibrillation have a high prevalence of anxiety and depression caused by the symptoms they experience thus resulting in a decreased quality of life (Gehi et al., 2012).
     • Shortness of breath
     • Atrial Fibrillation may be asymptomatic in some patients (Medical Advisory Secretariat, 2006)
     • Weakness
     • Heart palpitations
     • Chest pain
     • Sleep difficulties
     • Exercise intolerance (McCabe, Rhudy, Chamberlain, & DeVon, 2016).
   • Signs (Natale & Jalife, 2008).
     • Tachycardia
     • Reduced cardiac output
       • Symptoms include decreased limp temperature, increased core temperature, decreased urine output, and mottled skin colour (Cuadrado, 2002).
     • Radial pulse is lower than apical pulse (Lippincott, 2011).
     • Abnormal ECG findings (Lippincott, 2011)
       • Atrial activity is no longer represented by P waves but by fibrillatory waves (f waves). This rhythm may be either sustained or paroxysmal (occurring in bursts).
       • Irregular pulse rhythm
       • Undetectable atrial heart rate
       • Ventricular heart rate around 130 beats per minute
       • PQR - undetectable
       • T wave - undetectable
       • QT - unmeasurable
       • QRS complex - 0.08 second
       • The first figure shows a healthy ECG record. The second figure shows an ECG with atrial fibrillation (Queiroz, Junior, Lucena, & Barros, 2018).

2. Diagnostic Testing

3. Complications

   • Patients with may also experience increased morbidity and mortality from complications such as heart failure, strokes, hemorrhagic and thromboembolic complications, heart attacks and cardiovascular death (Jankowska-Polańska, Kaczan, Lomper, Nowakowski, & Dudek, 2018; Mogensen et al., 2017).
     • Roughly 44% of those with one of the three types of atrial fibrillation had a stroke.
     • Approximately 43% of those with any of the types of atrial fibrillation have been hospitalized for heart failure at some point.
     • Around 69% of the deaths of those with atrial fibrillation was due to a heart attack or other sudden cardiovascular event.

4. Classifications/Variations

5. Treatment and Management

   • Cardiac Ablation (Medical Advisory Secretariat, 2006).
     • Cardiac ablation involves using a probe with an electrode at the tip on cardiac tissue with the goal of scarring the area to prevent an electrical current from being conducted through the area.
       • Types
         • Segmental Pulmonary Vein Ablation: the pulmonary vein is isolated from the left atrium by applying lesions at the ostial region of the pulmonary veins.
         • Circumferential pulmonary vein ablation: surrounds the pulmonary veins in linear lesions on the left atrial myocardium outside the pulmonary vein ostia.
       • Catheter ablation is the procedure in which cardiac ablation is performed. It involves precisely inserting a catheter through the femoral vein to access the heart in order to perform the ablation procedure
   • Pharmacotherapy
     • Heart Rate Control. In order for heart rate to be considered controlled it must meet three goals: controlled at rest, controlled during activity, and regularization of the heart rate (Natale & Jalife, 2008).
       • Diltiazem or verapamil should be used as the preferred method over digoxin when using pharmacotherapy in controlling heart rate as it has a better effect on the control of heart rate during activity. Diltiazem or verapamil both have a rapid onset of action; this is especially important in acute situations. β-blockers are the best at controlling heart rate with activity. Atenolol, metoprolol, pindolol, and nadolol are all effective at controlling heart rates at rest and with exertion.
     • Pharmacological Cardioversion

6. Etiology

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