CCMS Medicine Spring 2017 - 8

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Mother of all Arrhythmias Part 1
BY MIAN AND ZARSHAWN JAN

Prevalence

Atrial fibrillation (AF) is the most common arrhythmia in the US.
Four percent of patients over the age of sixty will have AF, similarly
eight percent of patients over the age of eighty have AF, and
fourteen percent will develop AF in their lifetime. The first time
this irregularity was described by Jean Baptiste Senac was in 1749
and was first documented by ECG by Thomas Lewis in 1909.

Lone AF: usually benign occurring in younger patients, no
underlying cause, few symptoms and no structural heart disease.

Signs and Symptoms

Men are one and a half times more likely to develop AF than
women and Caucasians develop it more than African Americans.

Classification

There is certain terminology that we need to remember and
understand:

First detected: usually less than forty-eight hours during diagnosis
Paroxysmal: less than seven days and self-terminating
Persistent: exists for more than seven days and requires electrical or
pharmacological cardioversion
Permanent: sustained with failed cardioversion and everyone is in
agreement that rate control is the best option

8 CHESTER COUNTY Medicine | SPRING 2017

Usually related to the rapid heartbeat and can vary from
palpitations to syncope. The symptoms can be vague like exercise
intolerance and fatigue to devastating like CVA, CHF, and angina
pectoris. Sometimes the symptoms are so minimal diagnosis is
made by routine ECG.
Often symptoms depend on the primary cause of AF and mimic
their presentation.

Pathophysiology

Normally the sinoatrial node (SA node) in the right atrium
generates regular electrical impulses which results in mechanical
contraction. In AF this impulse is overwhelmed by disorganised
electrical activity located in the root of pulmonary veins. This
leads to irregular conduction of electrical impulse down the
atrioventricular node (AV node) and thus a faster irregular
heartbeat. Fortunately 300 to 500 impulses generated in the atria
are hampered by
their route down
the AV node and
only 100 to 150
reach the ventricle
or AF would be
immediately life
threatening. One
such scenario
is the accessory


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Table of Contents for the Digital Edition of CCMS Medicine Spring 2017

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