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Atrial Fibrillation

Omnia M. Korani Intern at Kasr Al-Aini school of medicine

Oct. 2014

Agenda What is Atrial Fibrillation?

Treatment for atrial fibrillation.

Surgical Treatment for Atrial Fibrillation.

Who is a candidate for the surgery?

Summery.

What is Atrial Fibrillation?

• Atrial fibrillation is the most common abnormal heart rhythm.

• Atrial fibrillation is an irregular, frequently rapid heart rhythm originating in the atria.

ECG diagnostic criteria:*Absent P waves . *Fibrillation (f) waves instead of P waves.

The f waves result in an oscillating irregular baseline.

*The R-R intervals are not equal resulting in an irregular rhythm.

• Atrial fibrillation doubles the risk of death.

• It also increases the risk of stroke five to seven times compared to a person without atrial fibrillation.

• In addition, atrial fibrillation may cause congestive heart failure and uncomfortable symptoms related to a rapid heart rate.

Treatment for atrial fibrillation

The goals of treatment for atrial fibrillation include:

• regaining a normal heart rhythm (sinus rhythm).

• controlling the heart rate.• preventing blood clots and reducing the

risk of stroke.

Treatment options:

1. Medical 2. Minimal invasive surgical 3. Open heart surgery

Medical Management of Atrial Fibrillation

• Rhythm control medications (antiarrhythmic drugs)

• Rate control medications (to slow the heart rate)• Anticoagulant or blood thinner to prevent blood

clots and stroke.

Anticoagulants (coumadin/warfarin)

Adjust the dose according to the INR ,Do blood tests every 4–8 weeks.Keep INR bet. 2:3

>2.5 if prosthetic valve.

Surgical Treatment for Atrial Fibrillation

• Surgical treatment for atrial fibrillation is considered when:

1. Medical therapy does not effectively control or correct atrial fibrillation

2. Medications for atrial fibrillation are not tolerated

3. Anticoagulants (coumadin/warfarin) is contraindicated

4. Blood clots, including strokes, occur.

• Minimally invasive surgery is an option for many patients with atrial fibrillation.

• Surgical treatment for atrial fibrillation also may be considered when surgery is needed to treat a coexisting heart condition, such as valve or coronary artery disease.

Catheter ablation• In catheter ablation, a long, thin tubes (catheters) is

inserted into the blood vessels as access to the heart.

• Electrodes at the catheter tips can use radiofrequency energy, extreme cold (cryotherapy) or heat to destroy these hot spots, scarring the tissue so that the erratic signals are normalized.

This corrects the arrhythmia without the need for medications or implantable devices.

Catheter Ablation

Surgical maze procedure.• The maze procedure is conducted during an

open-heart surgery.

• By creating multiple scars hence no conducting tissue that stop the current of abnormal electricity.

Maze Procedure

Atrioventricular (AV) node ablation.• If medications or other forms of catheter

ablation don't work, or side effect overcome the benefits. AV node ablation may be another option.

• The procedure involves applying

radiofrequency energy to the pathway connecting the upper chambers (atria) and lower chambers (ventricles) of your heart (AV node) through a catheter to destroy this small area of tissue.

Patient still need medications !!

• The procedure prevents the atria from sending electrical impulses to the ventricles. The atria continue to fibrillate, though.

• A pacemaker is then implanted to keep the ventricles beating properly. After AV node ablation, the patient need to continue to take blood-thinning medications to reduce the risk of stroke because your heart rhythm is still atrial fibrillation.

In summery • Treatment of AF :• Life style modifications (Quit smoking,

regular exercise, healthy diet) • Treatment of 1ry cause if possible

(thyrotoxicosis )• Medications (rate control , Anticoagulants )• Surgery (invasive , non invasive )

Thank You