Atrial fibrillation hyperthyroidism: Difference between revisions

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| colspan="3" align="center" bgcolor="#ABCDEF" | Conduction
| colspan="3" align="center" bgcolor="#ABCDEF" | Conduction
|-
|-
| <small>Sinus rhythm</small> [[Image:Heart conduct sinus.gif|none|230px]]
| <small>Sinus rhythm</small> [[Image:Heart conduct sinus.gif|none|75px]]
| <small>Atrial fibrillation</small> [[Image:Heart conduct atrialfib.gif|none|230px]]  
| <small>Atrial fibrillation</small> [[Image:Heart conduct atrialfib.gif|none|100px]]  
|}
|}
{{Infobox_Disease |
{{Infobox_Disease |
   Name          = Atrihttp://miles.wikidoc.org/skins/common/images/button_bold.pngal fibrillation |
   Name          = |
   Image          = SinusRhythmLabels.png |
   Image          =  |
   Caption        = The P waves, which represent depolarization of the atria, are irregular or absent during atrial fibrillation. |
   Caption        = |
   DiseasesDB    = 1065 |
   DiseasesDB    = 1065 |
   ICD10          = {{ICD10|I|48||i|30}} |
   ICD10          = {{ICD10|I|48||i|30}} |
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   OMIM          = |
   OMIM          = |
   MedlinePlus    = 000184 |
   MedlinePlus    = 000184 |
   eMedicineSubj  = med |
   eMedicineSubj  = |
   eMedicineTopic = 184 |
   eMedicineTopic = |
   eMedicine_mult = {{eMedicine2|emerg|46}} |  
   eMedicine_mult = |  
}}
}}
{{SI}}
{{Atrial fibrillation}}
{{WikiDoc Cardiology Network Infobox}}
{{CMG}}


'''Associate Editor-In-Chief:''' {{CZ}}
{{CMG}}; '''Associate Editor(s)-In-Chief:''' {{CZ}}; [[Varun Kumar, M.B.B.S.]]


{{Editor Join}}
'''''Synonyms and related keywords:''''' AF, Afib, fib
 
'''Synonyms and related keywords''': AF, Afib, fib


==Overview==
==Overview==
[[Atrial fibrillation]] occurs in '''10% to 25%''' of patients with [[hyperthyroidism]]. [[Beta blockers]] and [[CCB|non-dihydropyridine calcium channel blockers]] may be used to control ventricular rate.<ref name="pmid6734051">Clozel JP, Danchin N, Genton P, Thomas JL, Cherrier F (1984) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=6734051 Effects of propranolol and of verapamil on heart rate and blood pressure in hyperthyroidism.] ''Clin Pharmacol Ther'' 36 (1):64-9. PMID: [http://pubmed.gov/6734051 6734051]</ref> In patients with [[hyperthyroidism]], [[anticoagulation|oral anticoagulation]] may be recommended to prevent systemic embolism.<ref name="pmid1801769">Hirsh J (1991) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1801769 Oral anticoagulant drugs.] ''N Engl J Med'' 324 (26):1865-75. [http://dx.doi.org/10.1056/NEJM199106273242606 DOI:10.1056/NEJM199106273242606] PMID: [http://pubmed.gov/1801769 1801769]</ref> [[AF]] in the setting of [[thyrotoxicosis]] has been shown to be associated with [[heart failure|decompensated heart failure]].<ref name="pmid2329232">Robinson K, Frenneaux MP, Stockins B, Karatasakis G, Poloniecki JD, McKenna WJ (1990) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2329232 Atrial fibrillation in hypertrophic cardiomyopathy: a longitudinal study.] ''J Am Coll Cardiol'' 15 (6):1279-85. PMID: [http://pubmed.gov/2329232 2329232]</ref><ref name="pmid1822968">Russell JW, Biller J, Hajduczok ZD, Jones MP, Kerber RE, Adams HP (1991) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1822968 Ischemic cerebrovascular complications and risk factors in idiopathic hypertrophic subaortic stenosis.] ''Stroke'' 22 (9):1143-7. PMID: [http://pubmed.gov/1822968 1822968]</ref><ref name="pmid7666571">Shigematsu Y, Hamada M, Mukai M, Matsuoka H, Sumimoto T, Hiwada K (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7666571 Mechanism of atrial fibrillation and increased incidence of thromboembolism in patients with hypertrophic cardiomyopathy.] ''Jpn Circ J'' 59 (6):329-36. PMID: [http://pubmed.gov/7666571 7666571]</ref>


==ACC / AHA Guidelines- Hyperthyroidism (DO NOT EDIT) <ref name="Fuster"> Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Le Heuzey JY, Kay GN, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann S. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation- Executive Summary: executive summary: 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 Guidlines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006; 114: 700-752. PMID 16908781 </ref>==
==ACCF/AHA/HRS 2011 Guidelines- Hyperthyroidism (DO NOT EDIT) <ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 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. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref><ref name="pmid21382897">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21382897 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.] ''Circulation'' 123 (10):e269-367. [http://dx.doi.org/10.1161/CIR.0b013e318214876d DOI:10.1161/CIR.0b013e318214876d] PMID: [http://pubmed.gov/21382897 21382897]</ref>==
{{cquote|
{{cquote|
===Class I===
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]===
1. Administration of a [[beta blocker]] is recommended to control the rate of ventricular response in patients with [[AF]] complicating [[thyrotoxicosis]], unless contraindicated. ''(Level of Evidence: B)''
'''1.''' Administration of a [[beta blocker]] is recommended to control the rate of ventricular response in patients with [[AF]] complicating [[thyrotoxicosis]], unless contraindicated. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''


2. In circumstances when a [[beta blocker]] cannot be used, administration of a non [[dihydropyridine]] [[calcium channel antagonist]] ([[diltiazem]] or [[verapamil]]) is recommended to control the ventricular rate in patients with [[AF]] and [[thyrotoxicosis]]. ''(Level of Evidence: B)''
'''2.''' In circumstances when a [[beta blocker]] cannot be used, administration of a non [[dihydropyridine]] [[calcium channel antagonist]] ([[diltiazem]] or [[verapamil]]) is recommended to control the ventricular rate in patients with [[AF]] and [[thyrotoxicosis]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''


3. In patients with [[AF]] associated with [[thyrotoxicosis]], oral [[anticoagulation]] ([[INR]] 2.0 to 3.0) is recommended to prevent [[thromboembolism]], as recommended for [[AF]] patients with other risk factors for stroke. ''(Level of Evidence: C)''
'''3.''' In patients with [[AF]] associated with [[thyrotoxicosis]], oral [[anticoagulation]] ([[INR]] 2.0 to 3.0) is recommended to prevent [[thromboembolism]], as recommended for [[AF]] patients with other risk factors for stroke. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


4. Once a [[euthyroid state]] is restored, recommendations for antithrombotic prophylaxis are the same as for patients without [[hyperthyroidism]]. ''(Level of Evidence: C)''}}
'''4.''' Once a [[euthyroid state]] is restored, recommendations for antithrombotic prophylaxis are the same as for patients without [[hyperthyroidism]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}


==See Also==
==Vote on and Suggest Revisions to the Current Guidelines==
* [[The Living Guidelines: Diagnosis and Management of Atrial Fibrillation | The AF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]
* [[The Living Guidelines: Diagnosis and Management of Atrial Fibrillation | The AF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]


==Sources==
==Guideline Resources==
* The ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation <ref name="Fuster"> Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Le Heuzey JY, Kay GN, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann S. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation- Executive Summary: executive summary: 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 Guidlines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006; 114: 700-752. PMID 16908781 </ref>
*[http://content.onlinejacc.org/cgi/reprint/48/4/e149.pdf ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation] <ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 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. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref>
 
*[http://circ.ahajournals.org/content/123/10/e269.full.pdf 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation] <ref name="pmid21382897">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21382897 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.] ''Circulation'' 123 (10):e269-367. [http://dx.doi.org/10.1161/CIR.0b013e318214876d DOI:10.1161/CIR.0b013e318214876d] PMID: [http://pubmed.gov/21382897 21382897]</ref>
 
*[http://circ.ahajournals.org/content/117/8/1101.full.pdf ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter] <ref name="pmid18283199">Estes NA, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18283199 ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular 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 Clinical Performance Measures for Atrial Fibrillation): developed in collaboration with the Heart Rhythm Society.] ''Circulation'' 117 (8):1101-20. [http://dx.doi.org/10.1161/CIRCULATIONAHA.107.187192 DOI:10.1161/CIRCULATIONAHA.107.187192] PMID: [http://pubmed.gov/18283199 18283199]</ref>


==References==
==References==
{{reflist|2}}
{{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
{{refend}}
{{Electrocardiography}}
{{Circulatory system pathology}}
{{SIB}}


[[Category:Electrophysiology]]
[[Category:Electrophysiology]]

Revision as of 17:15, 30 October 2011

Conduction
Sinus rhythm
Atrial fibrillation
'
ICD-10 I48
ICD-9 427.31
DiseasesDB 1065
MedlinePlus 000184

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.

Synonyms and related keywords: AF, Afib, fib

Overview

Atrial fibrillation occurs in 10% to 25% of patients with hyperthyroidism. Beta blockers and non-dihydropyridine calcium channel blockers may be used to control ventricular rate.[1] In patients with hyperthyroidism, oral anticoagulation may be recommended to prevent systemic embolism.[2] AF in the setting of thyrotoxicosis has been shown to be associated with decompensated heart failure.[3][4][5]

ACCF/AHA/HRS 2011 Guidelines- Hyperthyroidism (DO NOT EDIT) [6][7]

“

Class I

1. Administration of a beta blocker is recommended to control the rate of ventricular response in patients with AF complicating thyrotoxicosis, unless contraindicated. (Level of Evidence: B)

2. In circumstances when a beta blocker cannot be used, administration of a non dihydropyridine calcium channel antagonist (diltiazem or verapamil) is recommended to control the ventricular rate in patients with AF and thyrotoxicosis. (Level of Evidence: B)

3. In patients with AF associated with thyrotoxicosis, oral anticoagulation (INR 2.0 to 3.0) is recommended to prevent thromboembolism, as recommended for AF patients with other risk factors for stroke. (Level of Evidence: C)

4. Once a euthyroid state is restored, recommendations for antithrombotic prophylaxis are the same as for patients without hyperthyroidism. (Level of Evidence: C)

”

Vote on and Suggest Revisions to the Current Guidelines

Guideline Resources

References

  1. ↑ Clozel JP, Danchin N, Genton P, Thomas JL, Cherrier F (1984) Effects of propranolol and of verapamil on heart rate and blood pressure in hyperthyroidism. Clin Pharmacol Ther 36 (1):64-9. PMID: 6734051
  2. ↑ Hirsh J (1991) Oral anticoagulant drugs. N Engl J Med 324 (26):1865-75. DOI:10.1056/NEJM199106273242606 PMID: 1801769
  3. ↑ Robinson K, Frenneaux MP, Stockins B, Karatasakis G, Poloniecki JD, McKenna WJ (1990) Atrial fibrillation in hypertrophic cardiomyopathy: a longitudinal study. J Am Coll Cardiol 15 (6):1279-85. PMID: 2329232
  4. ↑ Russell JW, Biller J, Hajduczok ZD, Jones MP, Kerber RE, Adams HP (1991) Ischemic cerebrovascular complications and risk factors in idiopathic hypertrophic subaortic stenosis. Stroke 22 (9):1143-7. PMID: 1822968
  5. ↑ Shigematsu Y, Hamada M, Mukai M, Matsuoka H, Sumimoto T, Hiwada K (1995) Mechanism of atrial fibrillation and increased incidence of thromboembolism in patients with hypertrophic cardiomyopathy. Jpn Circ J 59 (6):329-36. PMID: 7666571
  6. ↑ 6.0 6.1 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA 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
  7. ↑ 7.0 7.1 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 123 (10):e269-367. DOI:10.1161/CIR.0b013e318214876d PMID: 21382897
  8. ↑ Estes NA, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS et al. (2008) ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular 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 Clinical Performance Measures for Atrial Fibrillation): developed in collaboration with the Heart Rhythm Society. Circulation 117 (8):1101-20. DOI:10.1161/CIRCULATIONAHA.107.187192 PMID: 18283199

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