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| | [[File:Siren.gif|30px|link=Atrial fibrillation resident survival guide]]|| <br> || <br>
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| | [[Atrial fibrillation resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
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| | [[File:Critical_Pathways.gif|88px|link=Atrial fibrillation critical pathways]]|| <br> || <br>
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| | <small>Sinus rhythm</small> [[Image:Heart conduct sinus.gif|none|75px]]
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| | <small>Atrial fibrillation</small> [[Image:Heart conduct atrialfib.gif|none|100px]]
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| {{Atrial fibrillation}}
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| {{CMG}}; '''Associate Editor(s)-In-Chief:''' {{CZ}}; [[Varun Kumar, M.B.B.S.]]
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| ==Overview==
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| ==Atrial Fibrillation and Hyperthyroidism==
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| *[[Atrial fibrillation]] occurs in 10% to 25% of [[patients]] with [[hyperthyroidism]].<ref name="pmid6734051">Clozel JP, Danchin N, Genton P, Thomas JL, Cherrier F (1984) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=6734051 Effects of propranolol and of verapamil on heart rate and blood pressure in hyperthyroidism.] ''Clin Pharmacol Ther'' 36 (1):64-9. PMID: [http://pubmed.gov/6734051 6734051]</ref>
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| *Based on another study 15% of [[patients]] with [[hyperthyroidism]] develop [[atrial fibrillation]] in comparison to 4% chance of [[atrial fibrillation]] development in normal population. It's [[incidence]] is also more common in [[males]] and among [[hyperthyroidism]] [[patients]] with [[hyperthyroidism|triiodothyronine (T3) toxicosis]].<ref name="pmid19341475">{{cite journal| author=Bielecka-Dabrowa A, Mikhailidis DP, Rysz J, Banach M| title=The mechanisms of atrial fibrillation in hyperthyroidism. | journal=Thyroid Res | year= 2009 | volume= 2 | issue= 1 | pages= 4 | pmid=19341475 | doi=10.1186/1756-6614-2-4 | pmc=2680813 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19341475 }} </ref>
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| *On the other hand only near 1% of [[patients]] with new onset [[atrial fibrillation]] detected to have [[hyperthyroidism]]. In other words in the absence of [[hyperthyroidism]]'s [[symptoms]] and [[Medical sign|signs]], [[hyperthyroidism]] is not a common [[etiology]] for [[atrial fibrillation]].http://sumsearch.org/cite/default.aspx?todo=cite&q=10.1186%2F1756-6614-2-4&otool=&CheckBox_reviews=on&topic=rx&population=&intervention=&comparison=placebo&outcome=&eer=&cer=&outcometype=-&significance=yes&sens=&spec=&prev=
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| *Subclinical [[hyperthyroidism]] increases the risk of [[atrial fibrillation]] up to 3 fold. <ref name="pmid19341475">{{cite journal| author=Bielecka-Dabrowa A, Mikhailidis DP, Rysz J, Banach M| title=The mechanisms of atrial fibrillation in hyperthyroidism. | journal=Thyroid Res | year= 2009 | volume= 2 | issue= 1 | pages= 4 | pmid=19341475 | doi=10.1186/1756-6614-2-4 | pmc=2680813 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19341475 }} </ref><ref name="pmid8885821">{{cite journal| author=Krahn AD, Klein GJ, Kerr CR, Boone J, Sheldon R, Green M | display-authors=etal| title=How useful is thyroid function testing in patients with recent-onset atrial fibrillation? The Canadian Registry of Atrial Fibrillation Investigators. | journal=Arch Intern Med | year= 1996 | volume= 156 | issue= 19 | pages= 2221-4 | pmid=8885821 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8885821 }} </ref>
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| *Elevation of [[thyroid hormones]] in [[hyperthyroidism]] is responsible for [[chronotropic]] and [[dromotropic]] effects on [[heart]]. <ref name="pmid19341475">{{cite journal| author=Bielecka-Dabrowa A, Mikhailidis DP, Rysz J, Banach M| title=The mechanisms of atrial fibrillation in hyperthyroidism. | journal=Thyroid Res | year= 2009 | volume= 2 | issue= 1 | pages= 4 | pmid=19341475 | doi=10.1186/1756-6614-2-4 | pmc=2680813 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19341475 }} </ref>
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| *Numerous mechanisms have been explained about increased risk of [[atrial fibrillation]] among [[patients]] with [[hyperthyroidism]]. The following are some of the responsible mechanism:<ref name="pmid19341475">{{cite journal| author=Bielecka-Dabrowa A, Mikhailidis DP, Rysz J, Banach M| title=The mechanisms of atrial fibrillation in hyperthyroidism. | journal=Thyroid Res | year= 2009 | volume= 2 | issue= 1 | pages= 4 | pmid=19341475 | doi=10.1186/1756-6614-2-4 | pmc=2680813 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19341475 }} </ref>
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| **Increase in [[ventricle|left ventricular mass]] in addition to impaired [[ventricle|ventricular relaxation]] which lead to elevation of [[atrial|left atrial]] [[pressure]]
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| **[[Heart rate]] elevation and subsequent [[ischemia]]
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| **[[atrium|Atrial]] ectopic activity
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| **Decreased [[action potential]]
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| *The following are some of the well known [[risk factors]] for [[atrial fibrillation]] development among [[hyperthyroidsm]] [[patients]]: <ref name="pmid15302638">{{cite journal| author=Frost L, Vestergaard P, Mosekilde L| title=Hyperthyroidism and risk of atrial fibrillation or flutter: a population-based study. | journal=Arch Intern Med | year= 2004 | volume= 164 | issue= 15 | pages= 1675-8 | pmid=15302638 | doi=10.1001/archinte.164.15.1675 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15302638 }} </ref><ref name="pmid6723378">{{cite journal| author=Agner T, Almdal T, Thorsteinsson B, Agner E| title=A reevaluation of atrial fibrillation in thyrotoxicosis. | journal=Dan Med Bull | year= 1984 | volume= 31 | issue= 2 | pages= 157-9 | pmid=6723378 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6723378 }} </ref>
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| **[[Old age]]
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| **[[male|Male gender]]
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| **[[Coronary heart disease]]
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| **[[Congestive heart failure]]
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| **[[Valvular heart disease]]
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| *[[Atrial fibrillation]] in the setting of [[thyrotoxicosis]] has been shown to be associated with [[heart failure|decompensated heart failure]] and a significant increase in [[morbidity]] and [[mortality rate]].<ref name="pmid902055">{{cite journal| author=Staffurth JS, Gibberd MC, Fui SN| title=Arterial embolism in thyrotoxicosis with atrial fibrillation. | journal=Br Med J | year= 1977 | volume= 2 | issue= 6088 | pages= 688-90 | pmid=902055 | doi=10.1136/bmj.2.6088.688 | pmc=1631908 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=902055 }} </ref><ref name="pmid19341475">{{cite journal| author=Bielecka-Dabrowa A, Mikhailidis DP, Rysz J, Banach M| title=The mechanisms of atrial fibrillation in hyperthyroidism. | journal=Thyroid Res | year= 2009 | volume= 2 | issue= 1 | pages= 4 | pmid=19341475 | doi=10.1186/1756-6614-2-4 | pmc=2680813 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19341475 }} </ref><ref name="pmid2329232">Robinson K, Frenneaux MP, Stockins B, Karatasakis G, Poloniecki JD, McKenna WJ (1990) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2329232 Atrial fibrillation in hypertrophic cardiomyopathy: a longitudinal study.] ''J Am Coll Cardiol'' 15 (6):1279-85. PMID: [http://pubmed.gov/2329232 2329232]</ref><ref name="pmid1822968">Russell JW, Biller J, Hajduczok ZD, Jones MP, Kerber RE, Adams HP (1991) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1822968 Ischemic cerebrovascular complications and risk factors in idiopathic hypertrophic subaortic stenosis.] ''Stroke'' 22 (9):1143-7. PMID: [http://pubmed.gov/1822968 1822968]</ref><ref name="pmid7666571">Shigematsu Y, Hamada M, Mukai M, Matsuoka H, Sumimoto T, Hiwada K (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7666571 Mechanism of atrial fibrillation and increased incidence of thromboembolism in patients with hypertrophic cardiomyopathy.] ''Jpn Circ J'' 59 (6):329-36. PMID: [http://pubmed.gov/7666571 7666571]</ref>
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| *[[Beta blockers]] and [[CCB|non-dihydropyridine calcium channel blockers]] may be used to control [[ventricle|ventricular rate]].<ref name="pmid6734051">Clozel JP, Danchin N, Genton P, Thomas JL, Cherrier F (1984) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=6734051 Effects of propranolol and of verapamil on heart rate and blood pressure in hyperthyroidism.] ''Clin Pharmacol Ther'' 36 (1):64-9. PMID: [http://pubmed.gov/6734051 6734051]</ref>
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| *In [[patients]] with [[hyperthyroidism]], [[anticoagulation|oral anticoagulation]] may be recommended to prevent systemic [[embolism]].<ref name="pmid1801769">Hirsh J (1991) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1801769 Oral anticoagulant drugs.] ''N Engl J Med'' 324 (26):1865-75. [http://dx.doi.org/10.1056/NEJM199106273242606 DOI:10.1056/NEJM199106273242606] PMID: [http://pubmed.gov/1801769 1801769]</ref>
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| *Up to two-thirds of [[patients]] will reach [[sinus rhythm]] with appropriate [[treatment]] and control of [[hyperthyroidism]].<ref name="pmid19341475">{{cite journal| author=Bielecka-Dabrowa A, Mikhailidis DP, Rysz J, Banach M| title=The mechanisms of atrial fibrillation in hyperthyroidism. | journal=Thyroid Res | year= 2009 | volume= 2 | issue= 1 | pages= 4 | pmid=19341475 | doi=10.1186/1756-6614-2-4 | pmc=2680813 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19341475 }} </ref>
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| ==2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)<ref name="JanuaryWann2014">{{cite journal|last1=January|first1=C. T.|last2=Wann|first2=L. S.|last3=Alpert|first3=J. S.|last4=Calkins|first4=H.|last5=Cleveland|first5=J. C.|last6=Cigarroa|first6=J. E.|last7=Conti|first7=J. B.|last8=Ellinor|first8=P. T.|last9=Ezekowitz|first9=M. D.|last10=Field|first10=M. E.|last11=Murray|first11=K. T.|last12=Sacco|first12=R. L.|last13=Stevenson|first13=W. G.|last14=Tchou|first14=P. J.|last15=Tracy|first15=C. M.|last16=Yancy|first16=C. W.|title=2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society|journal=Circulation|year=2014|issn=0009-7322|doi=10.1161/CIR.0000000000000041}}</ref>==
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| | colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
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| | bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[Beta blockers]] are recommended to control [[ventricle|ventricular]] [[heart rate|rate]] in [[patients]] with [[atrial fibrillation]] complicating [[thyrotoxicosis]] unless [[contraindication|contraindicated]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
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| | bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' In circumstances in which a [[beta blocker]] cannot be used, a [[Calcium channel blocker#Non-dihydropyridine|nondihydropyridine calcium antagonist]] is recommended to control the [[ventricle|ventricular]] [[heart rate|rate]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
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| ==2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)<ref name="pmid21392637">{{cite journal| author=Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al.| title=2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. | journal=J Am Coll Cardiol | year= 2011 | volume= 57 | issue= 11 | pages= e101-98 | pmid=21392637 | doi=10.1016/j.jacc.2010.09.013 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21392637 }} </ref>==
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| ===Hyperthyroidism (DO NOT EDIT) <ref name="pmid21392637">{{cite journal| author=Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al.| title=2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. | journal=J Am Coll Cardiol | year= 2011 | volume= 57 | issue= 11 | pages= e101-98 | pmid=21392637 | doi=10.1016/j.jacc.2010.09.013 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21392637 }} </ref>===
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| {|class="wikitable"
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| | colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
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| | bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Administration of a [[beta blocker]] is recommended to control the [[heart rate|rate]] of [[ventricle|ventricular]] response in [[patients]] with [[atrial fibrillation]] complicating [[thyrotoxicosis]], unless [[contraindication|contraindicated]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
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| | bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' In circumstances when a [[beta blocker]] cannot be used, administration of a [[Calcium channel blocker|nondihydropyridine calcium channel antagonist]] ([[diltiazem]] or [[verapamil]]) is recommended to control the [[ventricle|ventricular]] [[heart rate|rate]] in [[patients]] with [[atrial fibrillation]] and [[Hyperthyroidism|thyrotoxicosis]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
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| | bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' In [[patients]] with [[atrial fibrillation]] associated with [[Hyperthyroidism|thyrotoxicosis]], [[mouth|oral]] [[anticoagulation]] ([[INR]] 2.0 to 3.0) is recommended to prevent [[thromboembolism]], as recommended for [[atrial fibrillation]] [[patients]] with other [[risk factors]] for [[stroke]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
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| | bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' Once a [[euthyroid]] state is restored, recommendations for [[Antithrombotic|antithrombotic]] [[Prophylaxis|prophylaxis]] are the same as for [[patients]] without [[hyperthyroidism]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
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| ==Sources==
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| *[http://content.onlinejacc.org/cgi/reprint/48/4/e149.pdf ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation] <ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.] ''Circulation'' 114 (7):e257-354. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref>
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| *[http://circ.ahajournals.org/content/123/10/e269.full.pdf 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation] <ref name="pmid21382897">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21382897 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.] ''Circulation'' 123 (10):e269-367. [http://dx.doi.org/10.1161/CIR.0b013e318214876d DOI:10.1161/CIR.0b013e318214876d] PMID: [http://pubmed.gov/21382897 21382897]</ref>
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| *[http://circ.ahajournals.org/content/117/8/1101.full.pdf ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter] <ref name="pmid18283199">Estes NA, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18283199 ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Clinical Performance Measures for Atrial Fibrillation): developed in collaboration with the Heart Rhythm Society.] ''Circulation'' 117 (8):1101-20. [http://dx.doi.org/10.1161/CIRCULATIONAHA.107.187192 DOI:10.1161/CIRCULATIONAHA.107.187192] PMID: [http://pubmed.gov/18283199 18283199]</ref>
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| ==References==
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| {{reflist|2}}
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| [[CME Category::Cardiology]]
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| [[Category:Electrophysiology]]
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| [[Category:Cardiology]]
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| [[Category:Emergency medicine]]
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