Introduction to AF,Learning Objectives,Describe the classification of A-fib Understand the arrhythmia mechanism Identify associated EGMs with A-fib Describe different treatment of A-fib,Introduction of AF:Definition,Atrial fibrillation is a rapid, irregular, and even chaotic form of atrial tachyarrhythmia- with an irregular ventricular response. On ECG lack of P waves Replaced by “f” wave irregularity of R waves,Introduction of AF:ECG,Grossly disorganized atrial electric activity that is irregular in rate and rhythm. “Wavy baseline”. Varied ventricular response. Can be diagnosed by ECG,Introduction of AF: IC ECG,Introduction of AF: Epidemiology,Most common clinically significant arrhythmia About 4% of the general adult population Account for 1/3 of all patient discharges with arrhythmia AF risk & prevalence increases with age 70s,J Cardiovasc Nurs 2004; 94,Introduction of AF :Epidemiology,Introduction of AF,JAMA 2001; 2370,Heart Rhythm Vol 4, No 6, June 2007,Paroxysmal Atrial Fibrillation: Recurrent AF (2 episodes), that terminates spontaneously within 7days Persistent Atrial Fibrillation: AF sustains 7 days, or lasts less than 7 days but necessitates pharmacologic or electrical cardioversion Longstanding Persistent Atrial Fibrillation: Continuous AF of greater than 1 year duration,Introduction of AF : Classification,Introduction of AF : Classification,Atrial Fibrillation is believed to be initiated by active firing foci localized near or within the Pulmonary Veins. However, those foci can initiate a single re-entry circuit that will cause an flutter-like pattern or create multiple circuits with extremely chaotic activation.,Nattel et al, Annu Rev Physiol 2000;62:5177,RAA,LAA,RAA,LAA,RAA,LAA,AVR,AVR,AVR,Multiple Circuit Reentry,Single circuit Reentry,Ectopic Focus,Introduction of AF :Mechanisms,MA,RPVs,LPVs,Origin of Ectopic Foci,Haissaguerre M et al: N Eng J Med 1998; 339: 659 66,In 1998, Haissaguerre et al. Reported the incidence of foci firing from with the PVs While the left image represent the location - the drawing on the right represents the firing incidence in a study performed before 1998, with the Left Superior PV being dominant.,Introduction of AF :Mechanisms,Introduction of AF : Risk,Stroke : Increased disability & mortality Thrombus mainly seen in LAA Decreased heart function & Heart Failure Associated with decreased QOL(quality of life) Heart Failure,Framingham investigators. Circulation.1998;98:946,Men mortality 1.9,Women mortality 1.5,Introduction of AF : Increased mortality,N Engl J Med 1969;281:555.,LAA small thrombus（5mm） LA large thrombus,Introduction of AF : Thrombosis,Introduction of AF : Symptoms,Palpitation Presyncope Dyspnoea, fatique, lightheadedness Syncope is uncommon Symptom associated with Stroke,Introduction of AF : Treatment,Rate control: control the heart rate Drugs Therapy AVN Ablation +Pacemaker Rhythm control: turn AF to NSR Anti-arrhythmic Drugs Surgery Catheter Ablation Anticoagulation therapy,Introduction of AF : Treatment,ACC/AHA/ESC Guidelines for Management of pts with atrial fibrillation; Circulation 2006;114:257354,* There is no approved catheter for ablation of Persistent Atrial fibrillation,Treatment of Atrial Fibrillation,Introduction of AF : Treatment-Rhythm Control,Antiarrhythmic Drug (AAD) Therapy Sometime together with cardioversion Benefit=Side effect Surgery Catheter Ablation,Current Drug Treatment Options,Sodium channel blockade,Bleeding and all issues associated. Requires constant monitoring of bleeding times,X,X,X,Anti-arrhythmic Drugs Used for Treatment of PAF,Surgery,Maze Procedure Most effective Corridor Procedure Open heart ablation Endoscopic surgery,Maze Procedure,Before Procedure,After Procedure,Incision Line,Maze III,LA Maze,Result from Surgery,2011 ACC/AHA/HRS Focused Update on the Management of Patients With Atrial Fibrillation (Updating the 2006 Guideline),Summary,The classification of A-fib Associated EGMs with A-fib The mechanism of A-fib The different treatment of A-fib,