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Critical Care
Atrial Fibrillation / Flutter
Atrial Fibrillation
Atrial Flutter
Rate
300-600 bpm
Ineffective and irregularly irregular
Atrial impulse reaches ventricle from varying angles
250-350 bpm
Regular pulsation
Ventricular response due to variable degree of conduction block (2:1)
Causes
Primary (structural)
Atrial dilatation (mitral valve disease)
Muscle hypertrophy
Inflammation, infiltration, fibrosis
Secondary
Right atrial re-entrant circuit
Ischaemic heart disease
Cardiomyopathy
Hyperthyroidism
Effects
Thrombi/Emboli
Rate-related ischaemia/effects
Management
Oxygen
Vagal manoeurvres
valsalva
Eyeball massage
carotid sinus massage
Chemical cardioversion
Drugs: IV adenosine (6/6/12) induces AV conduction delay - care in accessory pathways
Amiodarone
Electrical cardioversion
Surgical ablation of accessory pathway
Rate control
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