types and features and management of atrial arrhythmia's

1. PRESENTATION
ON
ATRIAL ARRHYTHMIAS
Presented by:
Baby Haokip
2nd Year MSc(N)
College of Nursing
NEIGRIHMS

2. What is meant by arrhythmias?
Too early
(premature)
Too fast
(Tachycardia) Too slow
(Bradycardia)
Irregularly
(Fibrillation
or
Flutter)

3. Rhythms originating in the atria:
 Premature atrial complexes (PACs),
 Wandering atrial pacemaker (WAP),
 Atrial Tachycardia,
 Multifocal atrial tachycardia (MAT),
 Atrial flutter, and
 Atrial Fibrillation

4. Premature atrial complexes (pacs):
 An atrial premature complexes results from premature, ectopic,
supraventricular impulse that originates somewhere in the atria
outside of the SA node

5. ETIOLOGY OF PACs:
Stress,
Caffeine,
Alcohol Digoxin
MIHeart failure
CAD
Valvular
Heart
disease

6. CHARACTERISTICS OF PACs:
RATE RHYTHM P-WAVE PR-INTERVAL QRS COMPLEX
Usually
Normal
Irregular Premature
and abnormal
or hidden
Normal or
prolong
depends on
prematurity
Normal or wide

7. Treatment of PAC:
 If symptomatic, eliminate the triggering factors
such as caffeine, alcohol.
 For frequent PACs, drugs such as beta-adrenergic
blockers and calcium channel blockers.

8. ATRIAL TACHYCARDIA:
 Atrial Tachycardia is a rapid atrial rhythm at a rate of 100 to 250
beats per minute that arises from a single site within the right or
left atrium.
 This rhythm may be due to rapid firing of an ectopic atrial focus
that allows an impulse to travel rapidly and repeatedly around a
pathway in the atria.

9. ETIOLOGY: Cor-
Pulmonale
VHD
RHD
COPDMI
Hypokalemia
Digitalis
toxicity
Atrial Tachycardia

10. Characteristics of Atrial tachycardia:
 Rate:
 Atrial: 100 – 200 bpm
 Ventricular: same or slower
 Rhythm: regular unless
block.
 P-wave: differs from sinus,
may be hidden preceding T
wave
 PR-interval: usually normal
but difficult to measure
 QRS: normal or widen

11. Treatment of Atrial Tachycardia:
Pharmacologic
Cardioversion:
Adinosine
Amiodarone
Beta-blockers
Ca. channel blockers
Digoxin

12. Multi-focal atrial tachycardia (MAT)
 MAT (also known as chaotic AT) is rapid firing of several
ectopic atrial foci at a rate faster than 100 beats per minute.

13. ETIOLOGY:
 Chronic pulmonary disease
 Heart Failure
 Hypokalemia,
 Hypomagnesemia,
 Hypoxia,
 Acute MI
 Mitral stenosis.

14. CHARACTERISTICS:
P-wave: varies
Rate: 100-130 bpm
Rhythm: irregular
P-wave: vary in shape, at
least three diff P-wave
identified.
PR-interval: may vary
QRS Complex: normal
QT interval: may be discernable
T-wave: distorted.

15. TREATMENT:
 Treatment of MAT is directed toward eliminating the
underlying causes, including hypoxia and electrolyte
imbalances.
 β-Blockers, verapamil, amiodarone, and magnesium
 If MAT is chronic and unresponsive to drug therapy,
radiofrequency ablation of the AV node and insertion of a
permanent pacemaker may be necessary to control the
ventricular rate.

16. ATRIAL FLUTTER:
 Atrial flutter is an organized atrial rhythm in which the atria
are depolarized at rates of 250 to 440 times per minute.

17. ETIOLOGY:
LV Dysfunction
RHD
Mitral Valve Disease
CAD
Thyrotoxicosis
Heart Failure
MI
Digoxin Toxicity

18. CHARACTERISTICS:
F-waves
Rate:
Atrial: 250-300
Vent: 150-300
Rhythm:
Atrial:regular
Vent: Irregular,
depends on AV block
P-wave: F-waves
seen, Sawtooth
Pattern
PR-interval: consistent
or vary
QRS: Normal
T-wave: not identifiable

19. TREATMENT:
 If patient haemodynamically unstable, and with atrial flutter of 48 hours
or less, immediate synchronized electrical cardioversion
 With atrial flutter of more than 48 hours, anticoagulation therapy before
and after cardioversion
 With normal heart function, beta adrenergic blockers such metoprolol or
calcium channel blockers such as Diltazem
 With impaired heart function (heart failure of EF below 40%) Digoxin or
Amiodarone
 Ablation therapy.

20. ATRIAL FIBRILLATION:
 Atrial Fibrillation is an extremely rapid and disorganized pattern of
depolarization in the atria.
Paroxysmal
PersistentPermanent

21. ETIOLOGY:
 Rheumatic heart disease,
 Thyrotoxicosis,
 HF,
 Cardiomyopathy,
 Valve disease,
 Pulmonary disease,
 MI,
 Congenital heart disease,
 With electrolyte imbalances,
 After cardiac surgery.

22. Characteristics of Atrial Fibrillation:
•Rate:
•Atrial: 400 – 600 bpm
•Vent: 60-100, depends on AV
blocks
•Rhythm: irregular
•P-wave: absent, irregular F-waves seen
•PR-interval: not measurable
•QRS Complex: normal

23. TREATMENT:
 Patient with normal heart function experiencing Atrial fibrillation:
 More than 48 hours: Calcium channel blockers, beta-adrenergic blockers
 Less than 48 hours: Amiodarone, procanamide
 Patient with impaired heart function: Digoxin, Diltazem
 Elective cardioversion
 Anticoagulation therapy.

24. WANDERING ATRIAL PACEMAKER:
 Wandering atrial pacemakers produces a supraventricular rhythm in
which pacemaker impulses originate from two or more sites in the
SA node, atria or AV junction and discharge at a rate of 60 to 100
beats per minute.

25. ETIOLOGY:
 Chronic lung disease (COPD)
 Digoxin toxicity
 Inflammation of atrial tissue.
 Valvular (especially mitral and tricuspid) Heart disease.

26. CHARACTERISTICS:
Rate: varies but within normal limits
Rhythm:
Atria: Varies with irregular P-P interval
Vent: Varies with irregular R-R interval
P-wave: differs
PR-interval: varies from beat to beat
QRS complex: normal

27. TREATMENT:
 Usually no treatment if patient is asymptomatic.
 If symptomatic treatment for wandering atrial pacemaker is geared
towards resolving the underlying cause.