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Atrial Fibrillation
Omnia M. Korani Intern at Kasr Al-Aini school of medicine
Oct. 2014
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Agenda What is Atrial Fibrillation?
Treatment for atrial fibrillation.
Surgical Treatment for Atrial Fibrillation.
Who is a candidate for the surgery?
Summery.
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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.
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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.
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• 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.
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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.
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Treatment options:
1. Medical 2. Minimal invasive surgical 3. Open heart surgery
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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.
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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.
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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.
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• 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.
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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.
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This corrects the arrhythmia without the need for medications or implantable devices.
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Catheter Ablation
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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.
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Maze Procedure
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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.
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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.
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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 )
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Thank You