Atrial fibrillation

Koch’s triangle- Tricuspid ring, tendon of Todoro, coronary sinus(base), near the His bundle (apex), anterior third(fast pathway), posterior third(slow)

Characteristic- Sustained arrhythmia, easy diagnosed, hard to treat

Mechanism 

1.Multicircuit reentry- atrial enlargement, structural heart disease

2.Macroreentry with fibrillatory conduction(mother wave)- young, no structural heart disease, pulmonary vein ablation

3.Hyperexcitably(rapid firing atrial foci)

Pattern

1.paroxysmal: 25%, <7 days, can ablation

2.persistent: 25%, >7 days, can ablation

3.permanent: 50%, >6 months

4.lone AF: 8%, young

Risk of stroke: HTN(70%), heart failure(40%), CAD(30%), DM(20%)

Complication: mortality(2x), admission(3x), stroke(5x)

Risk factor: Hypertension, CAD, valvular heart, hyperthyroidism, heart failure, HCM, cardiopulmonary, congenital heart, venous thromboembolic(DVT,PE), obesity, DM, metabolic syndrome, hypomagnesemia, inflammation/infection, surgery, CKD,  medication(theophylline, adenosine, digitalis, bisphosphonate), alcohol

Prevention of systemic embolization-  risk of embolization exceeds the risk of bleeding, CHA2DS2-VASc score, HAS-BLED score

Rhythm control- Make atrium not arrhythmia, antiarrhythmic drug therapy, percutaneous catheter ablation, and/or a surgical Maze procedure, Electrical cardioversion→ for <65yrs with symptomatic, <48hrs, no heart failure

Rate control- Make ventricle relax, beta blockers, non-dihydropyridine calcium channel blockers, or digoxin→ for >65yrs with asymptomatic, heart failure

Rate/rhythm control- symtomps, left ventricular systolic dysfunction

Published by Steve Johnson

I am a doctor who like to organise knowledges and share ideas with others. As a doctor, a lot of knowledges influx everyday and need some patient to organise and absorb. Here was my notes to share with you and hope to save your time to know it.

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