Atrial fibrillation

• in contrast to atrial flutter, the source is typically the left atrium

• very disorganized atrial arrhythmia

• very common—up to 10% of population over age 80

• rx: two strategies

  • 1 rate control: β-blockers, Ca-channel blockers, anticoagulation. leave the patient in atrial fibrillation and block the two bad things that happen (tachycardia, thrombosis)

  • 2 rhythm control: using electrical cardioversion, antiarrhythmic drugs, ablation in an attempt to maintain normal sinus rhythm. pts still need to be anticoagulated

• types

  • paroxysmal

    • starts and stops on its own

    • mechanism: abnormal automaticity and reentry, involving the entire atrium

    • treated medically using rate control and anticoagulation

    • ablation is challenging, but more likely succeed than for persistent AF

  • persistent

    • does not stop spontaneously. needs to be stopped with cardioversion, antiarrhytmics, or ablation

    • mechanisms are reentry and abnormal automaticity

    • treated with rate control medications and anticoagulation

    • ablation is very challenging and less likely to succeed

• ECG: “irregularly irregular RR intervals” or “irregularly irregular QRS complexes” without clear P wave and no flutter waves 40

• on physical exam, you can feel this

Category: Pathology Notes