1. ATRIAL FIBRILLATION
PRESENTED BY : KAMAL SYUKRI
SUPERVISED BY : DR ROHAYU (EP)

2. EPIDEOMOLOGY
• AF : commonest sustained cardiac arrythmia
• Mortality rate of patient AF: sinus rhythm= 2:1
- Prothrombotic state,
- Intra –atrial stasis
- Structural heart disease
- Abnormal platelets hemostasis

3. DEFINITION
• Atrial fibrillation (AF) is an atrial tachyarrhythmia characterized by uncoordinated atrial
activation with consequent deterioration of atrial mechanical function
• Characterized by ‘absolutely’ irregular RR intervals and the absence of any distinct P waves.
The P waves are replaced by fibrillary (F) wave

4. RISK FACTORS

5. PATHOPHYSIOLOGY

6. SIGNS AND SYMPTOMS
• Palpitations
• Chest pain
• Weakness
• Dizziness
• Syncope
• Malaise
• Reduced effort tolerance

7. DIAGNOSIS
• ECG
• HOLTER
• Transthoracic echocardiogram (TTE)
• Transesophageal echocardiogram (TOE)
• Baseline blood investigation + TFT

9. MANAGEMENT
• Rate control - unacceptable high ventricular rate
- Af with slow rate—atropine 0.5-2 mg
- Bradyarrhythmia—urgent placement of TPM/cardioversion
- Acute setting+absence of pre-excitation– b blockers/non dihydropyridine CCB
- Pre excitation—class I antiarrhythmic

11. • Acute AF in haemodynamically unstable pt
- Unstable AF
-those with a ventricular rate greater than 150 bpm
-with ongoing chest pains
-critical perfusion
• Cardioversion
- electrical
- pharmacological

12. • DCCV
• Recommended energy
-200J/greater with monophasic waveform
-100J/greater with biphasic waveform
-10-50J biphasic waveform for AF
• Complications:
-thromboembolic events
-post-cardioversion arrhythmias
-risks of general anaesthesia

13. COMPLICATIONS
• Ischemic stroke
• Heart failure
• Myocardial infarction
• Cardiac arrest

14. THROMBOEMBOLIC PROPHYLAXIS

15. MANAGEMENT OF CHRONIC AF
• ABC pathway
• A : anticoagulation/ avoid stroke
- CHADVAS x HASBLED
• B : better symptom control
-Rate control : pharmacological, non pharmacological
- Rhythm control : cardioversion, antiarrhythmic drugs, catheter ablation, maze procedure
• C : cardiovascular risk factors and concomitant diseases, detection and management

20. THANK YOU