Atrial fibrillation: Difference between revisions

Latest revision as of 03:26, 14 December 2022


Atrial Fibrillation Microchapters
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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Atrial Fibrillation from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Special Groups Postoperative AF Acute Myocardial Infarction Wolff-Parkinson-White Preexcitation Syndrome Hypertrophic Cardiomyopathy Hyperthyroidism Pulmonary Diseases Pregnancy ACS and/or PCI or valve intervention Heart failure

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram EKG Examples A-Fib with LBBB

Chest X Ray

Echocardiography

Holter Monitoring and Exercise Stress Testing

Cardiac MRI

Treatment

Rate and Rhythm Control

Cardioversion Overview Electrical Cardioversion Pharmacological Cardioversion

Anticoagulation Overview Warfarin Converting from or to Warfarin Converting from or to Parenteral Anticoagulants Dabigatran

Maintenance of Sinus Rhythm

Surgery Catheter Ablation AV Nodal Ablation Surgical Ablation Cardiac Surgery
Specific Patient Groups

Primary Prevention
Secondary Prevention

Supportive Trial Data

Cost-Effectiveness of Therapy

Case Studies

Case #1

Atrial fibrillation On the Web

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Powerpoint slides

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Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

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FDA on Atrial fibrillation

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Risk calculators and risk factors for Atrial fibrillation

For patient information, click here. Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2] Laith Adnan Allaham, M.D.[3]

Synonyms and keywords: AF; afib; lone fibrillator

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Atrial Fibrillation from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Special Groups

Diagnosis

Treatment

Dabigatran

Ablation

Catheter Ablation | AV Nodal Ablation | Surgical Ablation

Surgery

Maze Open Heart Surgery

Secondary Prevention

Supportive Trial Data

Cost-effectiveness of Therapy

Case Studies

Case #1

Related Chapters

Template:WikiDoc Sources CME Category::Cardiology

@@ Line 1: / Line 1: @@
-{| border="1" style="border-collapse:collapse" cellpadding="3" align="right"
+__NOTOC__
-| colspan="3" align="center" bgcolor="#ABCDEF" | Conduction
+{| class="infobox" style="float:right;"
+|-
+|[[File:Siren.gif|30px|link=Atrial fibrillation resident survival guide]]||<br>||<br>
+|[[Atrial fibrillation resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
+|}
+{| class="infobox" style="float:right;"
+|-
+|[[Image:Heart conduct sinus.gif|150px|]]<BR><small>'''Sinus rhythm'''</small>
+|}
+{| class="infobox" style="float:right;"
 |-
-| <small>Sinus rhythm</small> [[Image:Heart conduct sinus.gif|none|230px]]
+|[[Image:Heart conduct atrialfib.gif|150px]]<BR><small>'''Atrial fibrillation'''</small>
-| <small>Atrial fibrillation</small> [[Image:Heart conduct atrialfib.gif|none|230px]]
 |}
-{{Infobox_Disease |
+{{Atrial fibrillation}}
-  Name           = Atrial fibrillation |
+{{Patient}}
-  Image          = SinusRhythmLabels.png  |
+{{CMG}} {{AE}} {{Anahita}} {{Laith}}
-  Caption        = The P waves, which represent depolarization of the atria, are irregular or absent during atrial fibrillation. |
-  DiseasesDB     = 1065 |
-  ICD10          = {{ICD10|I|48||i|30}} |
-  ICD9           = {{ICD9|427.31}} |
-  ICDO           = |
-  OMIM           = |
-  MedlinePlus    = 000184 |
-  eMedicineSubj  = med |
-  eMedicineTopic = 184 |
-  eMedicine_mult = {{eMedicine2|emerg|46}} |
-}}
-{{SI}}
-{{WikiDoc Cardiology Network Infobox}}
-{{CMG}}
-'''Associate Editor-In-Chief:''' {{CZ}}
+{{SK}} AF; afib; lone fibrillator
-{{Editor Join}}
+==[[Atrial fibrillation overview|Overview]]==
+==[[Atrial fibrillation historical perspective|Historical Perspective]]==
-'''Synonyms and related keywords''': AF, Afib, fib
+==[[Atrial fibrillation classification|Classification]]==
-==Overview==
+==[[Atrial fibrillation pathophysiology|Pathophysiology]]==
-===[[Atrial fibrillation overview|Overview]]===
-===[[Atrial fibrillation epidemiology|Epidemiology]]===
-==Diagnosis==
+==[[Atrial fibrillation causes|Causes]]==
-===[[Atrial fibrillation diagnosis overview|Overview]]===
-===[[Atrial fibrillation classification|Classification]]===
-===[[Atrial fibrillation etiology and differential diagnosis|Etiology and Differential Diagnosis]]===
-==Treatment==
+==[[Atrial fibrillation differential diagnosis|Differentiating Atrial Fibrillation from other Diseases]]==
-===[[Atrial fibrillation pharmacological treatment|Pharmacological Treatment]]===
-===[[Atrial fibrillation invasive treatment|Invasive Treatment]]===
-===[[Atrial fibrillation surgical treatment|Surgical Treatment]]===
-==Surgical treatment of atrial fibrillation==
+==[[Atrial fibrillation epidemiology and demographics|Epidemiology and Demographics]]==
-===Maze procedure===
+==[[Atrial fibrillation risk factors|Risk Factors]]==
-{{main|Maze procedure}}
-James Cox, MD, and associates developed the Cox maze procedure, an open-heart surgical procedure intended to eliminate atrial fibrillation, and performed the first one in 1987. "Maze" refers to the series of incisions made in the atria, which are arranged in a maze-like pattern. The intention was to eliminate AF by using incisional scars to block abnormal electrical circuits (atrial macro reentry) that AF requires. This procedure required an extensive series of endocardial (from the inside of the heart) incisions through both atria, a median sternotomy (vertical incision through the breastbone) and cardiopulmonary bypass (heart-lung machine). A series of improvements were made, culminating in 1992 in the Cox maze III procedure, which is now considered to be the "gold standard" for effective surgical cure of AF. The Cox maze III is sometimes referred to as the "traditional maze", the "cut and sew maze", or simply the "maze".<ref>{{cite journal |author=Cox JL, Schuessler RB, Lappas DG, Boineau JP |title=An 8 1/2-year clinical experience with surgery for atrial fibrillation |journal=Ann. Surg. |volume=224 |issue=3 |pages=267-73; discussion 273-5 |year=1996 |pmid=8813255 |doi=}}</ref>
+==[[Atrial fibrillation screening|Screening]]==
-Minimaze surgery is minimally invasive cardiac surgery similarly intended to cure atrial fibrillation.  The "Minimaze" procedure refers to "mini" versions of the original maze procedure.  These procedures are less invasive than the Cox maze procedure and do not require a median sternotomy (vertical incision in the breastbone) or [[cardiopulmonary bypass]] (heart-lung machine). These procedures use microwave, radiofrequency, or acoustic energy to ablate atrial tissue near the pulmonary veins.
+==[[Atrial fibrillation natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
-== Prognosis ==
+==Special Groups==
+[[Postoperative atrial fibrillation|Postoperative AF]] | [[Atrial fibrillation acute myocardial infarction|Acute Myocardial Infarction]] | [[Atrial fibrillation Wolff-Parkinson-White preexcitation syndromes|Wolff-Parkinson-White Preexcitation Syndromes]] | [[Atrial fibrillation hypertrophic cardiomyopathy|Hypertrophic Cardiomyopathy]] | [[Atrial fibrillation hyperthyroidism|Hyperthyroidism]] | [[Atrial fibrillation pulmonary diseases|Pulmonary Diseases]] | [[Atrial fibrillation pregnancy|Pregnancy]] | [[Atrial fibrillation medical therapy in patients presenting with ACS and/or PCI or valve intervention|Patients Presenting with ACS and/or PCI or Valve Intervention]]
+==Diagnosis==
+[[Atrial fibrillation history and symptoms|History and Symptoms]] | [[Atrial fibrillation physical examination|Physical Examination]] | [[Atrial fibrillation laboratory findings|Laboratory Findings]] | [[Atrial fibrillation electrocardiogram|Electrocardiogram]] | [[Atrial fibrillation EKG examples|EKG Examples]] | [[Atrial fibrillation with LBBB EKG examples|Afib with LBBB EKG Examples]] | [[Atrial fibrillation chest x ray|Chest X Ray]] | [[Atrial fibrillation echocardiography or ultrasound|Echocardiography]] | [[Atrial fibrillation other imaging findings|Holter Monitoring and Exercise Stress Testing]] |  [[Atrial fibrillation cardiac MRI|Cardiac MRI]]
+==[[Atrial fibrillation overview of treatment|Treatment]]==
+===[[Atrial fibrillation rate control|Rate and Rhythm Control]]===
+[[Atrial fibrillation rate control|Rate Control]] | [[Atrial fibrillation maintenance of rate control and sinus rhythm|Maintenance of Sinus Rhythm]]
-==Follow up & Secondary prevention==
+===Cardioversion===
+[[Atrial fibrillation cardioversion|Overview]] | [[Atrial fibrillation electrical cardioversion|Electrical Cardioversion]] | [[Atrial fibrillation pharmacological cardioversion|Pharmacological Cardioversion]]
-===Risk factors for ischemic stroke or systemic embolization in patient with non valvular [[atrial fibrillation]]===
+===Anticoagulation===
-Numbers represents relative risks<ref>Estes NAM 3rd, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS, McNamara RL, Messer JV, Ritchie JL, Romeo SJW, Waldo AL, Wyse DG. ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with non valvular atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Performance Measures for Atrial Fibrillation). Circulation 2008; 117:1101–1120</ref>
+[[Atrial fibrillation anticoagulation|Overview]] | [[Warfarin]] | [[Dabigatran#Converting from or to Warfarin|Converting from or to Warfarin]] | [[Dabigatran#Converting from or to Parenteral Anticoagulants|Converting from or to Parenteral Anticoagulants]] | [[Dabigatran]]
-#Advanced age (continuous, per decade)                                            1.4
-#History of [[hypertension]]                                                      1.6
-#[[Heart failure]] or impaired left ventricular systolic function                 1.4
-#[[Coronary artery disease]] (CAD)                                                1.5
-#[[Diabetes mellitus]] (DM)                                                       1.7
-#Previous [[stroke]] or [[Transient Ischemic Attack]] (TIA)                       2.5
-==Clinical Trial Data==
+===Dabigatran===
+[[dabigatran#Dosing|Dosing]] | [[Dabigatran#Surgery and Interventions|Discontinuation for Surgery and Interventions]] | [[Dabigatran#WARNINGS AND PRECAUTIONS| Warnings and Precautions]] | [[Dabigatran#Adverse Reactions|Adverse Reactions]] | [[Dabigatran#Use in Specific Populations|Use in Specific Populations Such as Pregnancy]] | [[Dabigatran#Overdosage|Overdosage]] | [[Clinical Pharmacology of Dabigatran|Clinical Pharmacology]] | [[FDA Review of Data From the RE-LY Trial on September 20th, 2010|FDA Review of the RE-LY Data]] | [[A comparison of the RE-LY and Rocket AF Trials ]] | [[Estimates of Cost Per Year of Life Saved for Dabigatran]]
-Results from the Pulmonary Vein Antrum Isolation versus AV Node Ablation with Bi-Ventricular Pacing for Treatment of Atrial Fibrillation in Patients with Congestive Heart Failure (PABA-CHF) study suggest that pulmonary-vein (PV) isolation leads to better morphologic and functional results than atrioventricular (AV) node ablation with biventricular pacing for congestive heart failure (CHF) in patients with atrial fibrillation.
+===Ablation===
+[[Atrial fibrillation catheter ablation|Catheter Ablation]] | [[AV nodal ablation|AV Nodal Ablation]] | [[Atrial fibrillation surgical ablation|Surgical Ablation]]
-In this prospective, multicenter study, 41 patients were randomized to PV isolation and 40 to AV node ablation with biventricular pacing. At 6 months, patients in the PV isolation group had higher mean ejection fractions (35% vs 29%, p<0.001), greater 6 minute distances walked (340 vs 297 meters, p <0.001), and better quality of life scores as determined by the Minnesota Living with Heart Failure questionnaire (60 vs 82, p<0.001, where lower scores indicate better quality of life) than those in the AV node ablation arm.
+===Surgery===
+[[Atrial fibrillation surgical treatment|Maze Open Heart Surgery]]
-These PABA-CHF study findings thus suggest the potential advantages of performing PV isolation over AV node ablation with biventricular pacing for this patient population.
+===[[Atrial fibrillation secondary prevention|Secondary Prevention]]===
-Noted limitations of the study include using sites with extensive experience in performing ablations, an unblinded study design, and a relatively short follow-up time. (NEJM by Mohammed N. Khan, et al.)
+===[[Atrial fibrillation supportive trial data|Supportive Trial Data]]===
+===[[Atrial fibrillation cost-effectiveness of therapy|Cost-effectiveness of Therapy]]===
-==[[The Living Guidelines: Diagnosis and Management of Atrial Fibrillation|Guidelines: Diagnosis and Management of Atrial Fibrillation]]==
+==Case Studies==
+[[Atrial fibrillation case study one|Case #1]]
-==External links==
+==Related Chapters==
-* [http://www.americanheart.org/presenter.jhtml?identifier=4451 American Heart Association's page on atrial fibrillation]
+*[[Atrial flutter]]
-* [http://www.patient.co.uk/showdoc/23068682/ Atrial fibrillation]
+*[[Ashman phenomenon]]
-* [http://www.jr2.ox.ac.uk/bandolier/booth/booths/AF.html Bandolier: Evidence-based medicine resource on atrial fibrillation]
+*[[The Living Guidelines: Diagnosis and Management of Atrial Fibrillation | The AF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]
-* [http://my.clevelandclinic.org/heart/webchat/atrialfibrillation011608.aspx Cleveland Clinic Webchat - Atrial Fibrillation Webchat with Dr. Jennifer Cummings]
-==See also==
-* [[Atrial flutter]]
-* [[Ashman phenomenon]]
-==[[EKG Examples of atrial fibrillation]]==
-==External EKG Sources==
-*[http://www.emedu.org/ecg_lib/index.htm John Vozenilek's (MD) ECG Collection]
-*[http://www.ecgpedia.org ECGpedia]
-==References==
-{{reflist|2}}
-==Further Readings==
-{{refbegin|2}}
-* Fuster V, Rydén LE, Cannom DS, et al (2006). "ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". Circulation 114 (7): e257-354. doi:10.1161/CIRCULATIONAHA.106.177292. PMID 16908781.
-* Estes NAM 3rd, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS, McNamara RL, Messer JV, Ritchie JL, Romeo SJW, Waldo AL, Wyse DG. ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with non valvular atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Performance Measures for Atrial Fibrillation). Circulation 2008; 117:1101–1120
-* Braunwald's Heart Disease, Libby P, 8th ed., 2007, ISBN 978-1-41-604105-4
-* Hurst's the Heart, Fuster V, 12th ed. 2008, ISBN 978-0-07-149928-6
-* Willerson JT, Cardiovascular Medicine, 3rd ed., 2007, ISBN 978-1-84628-188-4
-{{refend}}
 {{Electrocardiography}}
 {{Circulatory system pathology}}
-{{SIB}}
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+[[Category:Up-To-Date]]
-[[de:Vorhofflimmern]]
+[[Category:Up-To-Date Cardiology]]
-[[fr:Fibrillation auriculaire]]
-[[it:Fibrillazione atriale]]
-[[nl:Boezemfibrilleren]]
-[[ja:心房細動]]
-[[no:Atrieflimmer]]
-[[pl:Migotanie przedsionków]]
-[[ro:Fibrilaţia Atrială]]
-[[fi:Eteisvärinä]]
-[[zh:心房颤动]]
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v t e Electrocardiography
Overview	History of the EKG • EKG interpretation basics • Normal sinus rhythm
EKG Complexes	P wave • QRS complex • ST Segment • T wave • T wave alternans • Tombstone T wave • U wave Osborn wave • H wave • K wave • Delta wave NSSTW changes
EKG Intervals	PR Interval • QRS Interval • ST Interval • QT Interval
Conduction System & Bradycardia	Cardiac pacemaker • SA node • AV node• Bundle of His • Purkinje fibers • Sinus bradycardia • First Degree AV Block • Second Degree AV Block • Complete or Third-Degree AV Block • Concealed conduction • AV Junctional Rhythms • LBBB • LAHB • LPHB • RBBB • Trifascicular block
Atrial Arrhythmias	Sinus tachycardia • Premature Atrial Contractions (PACs) • Ectopic Atrial Rhythm • Paroxysmal Atrial Tachycardia (PAT) • Paroxysmal Atrial Tachycardia (PAT) with Block • Multifocal Atrial Tachycardia (MAT) • Atrial Flutter • Atrial Fibrillation • Wandering atrial pacemaker
Ventricular Arrhythmias	Differential Diagnosis of Tachycardia with a Wide QRS Complex • Accelerated Idioventricular Rhythm • Ventricular Parasystole • Premature Ventricular Contractions (PVCs) • Ventricular tachycardia • Ventricular Fibrillation • Sudden cardiac death
EKG Abnormalities in Disease States	Hypertrophy & Dilatation • Right atrial enlargement • Left atrial enlargement • Biatrial enlargement • Left Ventricular Hypertrophy • Right Ventricular Hypertrophy • Biventricular Hypertrophy • Acute myocardial infarction • NSTEMI • STEMI • Tombstone ST elevation • Right ventricular myocardial infarction • Atrial infarction Pre-excitation Syndromes • Wolff-Parkinson-White Syndrome • Lown Ganong Levine Syndrome • Mahaim Type Preexcitation Cardiomyopathies • Arrhythmogenic Right Ventricular Dysplasia • Dilated Cardiomyopathy • Hypertrophic Cardiomyopathy Drug Effects on the EKG • Adenosine • β-blockers • Digitalis • Quinidine • Procainamide • Disopyramide • Lidocaine • Tocainide and Mexiletine • Phenytoin • Encainide, Flecainide and Propafenone • Amiodarone • Bretylium • Ca Channel Blockers • Phenothiazines • Tricyclic Antidepressants • Lithium Congenital Heart Disease • Dextrocardia • Atrial Septal Defect • Ventricular Septal Defect • Tetralogy of Fallot • Conjoined Twins or Siamese Twins • Congenital heart block Electrolyte Disturbances • Hyperkalemia • Hypokalemia • Hypercalcemia • Hypocalcemia • Nonspecific Changes Other Heart Diseases • Pericarditis • Myocarditis • Tamponade • Heart Transplantation • Sick Sinus Syndrome • Long QT Syndrome Inherited Disease • Brugada Syndrome Systemic Diseases • CNS Disease • Cardiac Tumors Heart Transplantation • EKG Changes in patient with Heart Transplantation Exogenous Effects • Hypothermia • Chest Trauma • Insect Bites • Electric Injuries
Technical Issues and Potential Errors in Interpretation	Artifacts • Lead Placement Errors • The EKG in a Patient with a Pacemaker • EKG in athletes