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Let’s take a closer look at atrial fibrillation. There are three main types of atrial fibrillation. Paroxysmal: which describes transient episodes that stop on their own, and may last anywhere from seconds or minutes, to hours and up to a week. The next is persistent atrial fibrillation, and that defines episodes which last more than a week; or episodes lasting less than a week and are only stopped by either pharmacological or electrical cardioversion. The last one is something called “Long-Standing Persistent Atrial Fibrillation” which is a type of persistent a-fib that lasts longer than one year. This was formerly known more as chronic or permanent atrial fibrillation. The nature of atrial fibrillation is where multiple electrical impulses are being generated in the atria at the same time and therefore cause chaotic myocardial responses which may diminish the pre-load and effectiveness of the cardiac contraction. That may also cause the development of micro emboli due to the stagnant blood flow from the atria, and in some cases, this leads to a rapid ventricular response secondary to a re-entry problem. The electrical pattern will have no discernable P-waves but instead, show a fibrillatory wave between each QRS complex. Now, because there’s a lack of coordinated electrical impulses generated from the atria traveling through the AV node and to the ventricles, the result is an irregular ventricular response which also occurs irregularly. So now, using that whole system we just talked about, let’s break down the ECG of atrial fibrillation. First, let’s look at the rhythm: Is the rhythm regular or irregular? No, the rhythm is irregularly irregular. Next, let’s look at rate. Well,what is the rate? In this case the rate is still 80 beats per minute. We ask ourselves, is the rate normal, fast or slow? The rate is variable because of its irregularity. Then we evaluate the P-wave: Are they present? Nope, not in this case. The P-waves are not present. Do they occur regularly? No, because there are no P-waves. Is there one P-wave for each QRS complex? No, the answer is that there is no P-wave for each QRS complex. Are the P-Waves smooth, rounded, and upright? Again, no. Only fibrillatory waves are seen. So in this case, if we were to ask, do all the P-waves have similar shapes? Again, we would have to say no. So now we want to know what the PR interval is for this ECG. Does the PR interval fall within the normal 0.12-0.20 seconds? Not at all, because there isn’t a PR interval. Is the PR interval constant? Again, this doesn’t apply because there isn’t a P-wave. So next we move on to the QRS complex of the ECG. Is the QRS interval less than 0.12 seconds? Yes. The QRS is within normal range. Is the QRS wide or narrow? Well in this case, the QRS is still narrow. Are the QRS complexes similar in appearance? Here we can see that each one does look similar. Now, here’s my cardiac interpretation based on this ECG. It appears that this patient has atrial fibrillation. The causes can be many but the following are some of the most common underlying reasons. Congestive heart failure patients or those with a previous history where the patient may have damage to the SA node, the patient has a conduction system dysfunction from a current or past myocardial infarction or has experienced a traumatic injury. The patient has a disease process, maybe used or uses harmful drugs or has a metabolic disorder. Common side effects from atrial fibrillation include but are not limited to, a higher risk for coronary, cerebral or pulmonary embolism and as a result of the increased potential for microemboli to develop secondary to the lack of circulation of blood from the atria. Another complication discussed above is the rapid ventricular response due to the atrial fibrillation which can accelerate the ventricular rate to above 100 beats per minute. Atrial fibrillation combined with higher ventricular rates may decrease the amount of blood ejected from the heart due to the lack of what is sometimes referred to as the preloading atrial kick.
Atrial fibrillation (also called AFib or AF) is a quivering or irregular heartbeat (arrhythmia) that can lead to blood clots, stroke, heart failure, and other heart-related complications.
In this lesson, we'll look at the three types of atrial fibrillation and then look at a typical ECG readout for an adult patient in AFib and provide a cardiac interpretation. And at the end of the lesson, we'll look at some common causes and side effects of AFib in adult patients.
Paroxysmal, or transient atrial fibrillation, is defined by the following:
Persistent atrial fibrillation is defined by the following:
Long-standing persistent atrial fibrillation, formerly known as chronic or permanent atrial fibrillation, is defined as episodes that last longer than a year.
Atrial fibrillation occurs when multiple electrical impulses are being generated in the atria and at the same time, which causes chaotic myocardia responses.
AFib can diminish the preload and effectiveness of the cardiac contractions. This action could then cause the development of microemboli due to stagnant blood flow from the atria. In certain instances, this will even lead to a rapid ventricular response that's secondary to a reentry problem.
Pro Tip: The electrical pattern on an ECG will have no discernible P-waves, but instead, will show fibrillatory waves between each QRS complex. And because there's a lack of coordinated electrical impulses generated from the atria traveling through the AV node into the ventricles, the result is usually an irregular ventricular response, which also occurs irregularly.
Now let's take a look at an ECG for an adult patient in atrial fibrillation.
*Atrial Fibrillation ECG for Adult Patient
The first thing you'll want to look at is the heart rhythm. Does the heart rhythm look regular? Or does it look irregular? In the ECG above, the rhythm is irregular.
Next, you'll want to look at the heart rate of the patient. What is the patient's heart rate? Is it normal? Or is it too slow or too fast? In this case, it's 80 beats per minute, which is within normal range, but it's also variable because of its irregularity.
After looking at the heart rate, check to see if the patient's P-waves look normal by asking yourself the following few questions.
Next, look at the PR interval on the patient's ECG readout and ask yourself the following questions:
The last thing you should look at to determine if the sinus rhythm is normal or not is the QRS complex and ask yourself these questions while you do:
So, what is your cardiac interpretation? Based on these questions and on the findings from the ECG readout above, it would appear that this patient is in atrial fibrillation.
The causes of AFib are numerous, but some common underlying reasons for it are:
Common side effects of AFib include but aren't limited to: