Atrial fibrillation pulmonary diseases: Difference between revisions

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| colspan="3" align="center" bgcolor="#ABCDEF" | Conduction
| colspan="3" align="center" bgcolor="#ABCDEF" | Conduction
|-
|-
| <small>Sinus rhythm</small> [[Image:Heart conduct sinus.gif|none|230px]]
| <small>Sinus rhythm</small> [[Image:Heart conduct sinus.gif|none|75px]]
| <small>Atrial fibrillation</small> [[Image:Heart conduct atrialfib.gif|none|230px]]  
| <small>Atrial fibrillation</small> [[Image:Heart conduct atrialfib.gif|none|100px]]  
|}
|}
{{Infobox_Disease |
{{Infobox_Disease |
   Name          = Atrihttp://miles.wikidoc.org/skins/common/images/button_bold.pngal fibrillation |
   Name          = |
   Image          = SinusRhythmLabels.png |
   Image          =  |
   Caption        = The P waves, which represent depolarization of the atria, are irregular or absent during atrial fibrillation. |
   Caption        = |
   DiseasesDB    = 1065 |
   DiseasesDB    = 1065 |
   ICD10          = {{ICD10|I|48||i|30}} |
   ICD10          = {{ICD10|I|48||i|30}} |
Line 15: Line 15:
   OMIM          = |
   OMIM          = |
   MedlinePlus    = 000184 |
   MedlinePlus    = 000184 |
   eMedicineSubj  = med |
   eMedicineSubj  = |
   eMedicineTopic = 184 |
   eMedicineTopic = |
   eMedicine_mult = {{eMedicine2|emerg|46}} |  
   eMedicine_mult = |  
}}
}}
{{SI}}
{{Atrial fibrillation}}
{{WikiDoc Cardiology Network Infobox}}
{{CMG}}; '''Associate Editor(s)-In-Chief:''' {{CZ}}; [[Varun Kumar, M.B.B.S.]]
{{CMG}}


'''Associate Editor-In-Chief:''' {{CZ}}
'''''Synonyms and related keywords:''''' AF, Afib, fib
 
{{Editor Join}}
 
'''Synonyms and related keywords''': AF, Afib, fib


==Overview==
==Overview==
In patients with [[COPD]], supraventricular arrhythmias, including [[atrial fibrillation]] are common.<ref name="pmid2454781">Shih HT, Webb CR, Conway WA, Peterson E, Tilley B, Goldstein S (1988) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2454781 Frequency and significance of cardiac arrhythmias in chronic obstructive lung disease.] ''Chest'' 94 (1):44-8. PMID: [http://pubmed.gov/2454781 2454781]</ref><ref name="pmid4122207">Hudson LD, Kurt TL, Petty TL, Genton E (1973) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=4122207 Arrhythmias associated with acute respiratory failure in patients with chronic airway obstruction.] ''Chest'' 63 (5):661-5. PMID: [http://pubmed.gov/4122207 4122207]</ref> In patients with acute exacerbations of [[COPD]], the presence of [[AF]] has shown to have worst prognosis.<ref name="pmid7872344">Fuso L, Incalzi RA, Pistelli R, Muzzolon R, Valente S, Pagliari G et al. (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7872344 Predicting mortality of patients hospitalized for acutely exacerbated chronic obstructive pulmonary disease.] ''Am J Med'' 98 (3):272-7. PMID: [http://pubmed.gov/7872344 7872344]</ref> The first step in the management is to treat the underlying lung disease and correct [[hypoxia]] and acid-base imbalance. [[Theophylline]] and [[beta adrenergic agonists]], which are commonly used to relieve
[[bronchospasm]], may precipitate [[atrial fibrillation]]. In patients with [[bronchospasm]], [[beta blockers]], [[sotalol]], [[propafenone]], and [[adenosine]] are '''contraindicated'''. [[CCB|Non-dihydropyridine calcium channel blocker]] and intravenous [[flecainide]]<ref name="pmid8163757">Barranco F, Sanchez M, Rodriguez J, Guerrero M (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8163757 Efficacy of flecainide in patients with supraventricular arrhythmias and respiratory insufficiency.] ''Intensive Care Med'' 20 (1):42-4. PMID: [http://pubmed.gov/8163757 8163757]</ref> may be used to restore sinus rhythm. However, in hemodynamically unstable patients [[Atrial fibrillation cardioversion|direct-current cardioversion]] may be attempted. In patients refractory to drug therapy, [[Atrial fibrillation invasive treatment|AV nodal ablation]] and ventricular pacing may be necessary to control the ventricular rate.


==ACC / AHA Guidelines- Pulmonary Diseases (DO NOT EDIT) <ref name="Fuster"> Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Le Heuzey JY, Kay GN, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann S. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation- Executive Summary: executive summary: 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 Guidlines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006; 114: 700-752. PMID 16908781 </ref>==
==ACCF/AHA/HRS 2011 Guidelines- Pulmonary Diseases (DO NOT EDIT) <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><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>==
{{cquote|
{{cquote|
===Class I===
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]===
1. Correction of [[hypoxemia]] and [[acidosis]] is the recommended primary therapeutic measure for patients who develop [[AF]] during an acute [[pulmonary illness]] or exacerbation of chronic [[pulmonary disease]]. ''(Level of Evidence: C)''
'''1.''' Correction of [[hypoxemia]] and [[acidosis]] is the recommended primary therapeutic measure for patients who develop [[AF]] during an acute [[pulmonary illness]] or exacerbation of chronic [[pulmonary disease]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


2. A non [[dihydropyridine]] [[calcium channel antagonist]] ([[diltiazem]] or [[verapamil]]) is recommended to control the ventricular rate in patients with [[obstructive pulmonary disease]] who develop [[AF]]. ''(Level of Evidence: C)''
'''2.''' A non [[dihydropyridine]] [[calcium channel antagonist]] ([[diltiazem]] or [[verapamil]]) is recommended to control the ventricular rate in patients with [[obstructive pulmonary disease]] who develop [[AF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


3. [[Direct-current cardioversion]] should be attempted in patients with [[pulmonary disease]] who become hemodynamically unstable as a consequence of [[AF]]. ''(Level of Evidence: C)''
'''3.''' [[Direct-current cardioversion]] should be attempted in patients with [[pulmonary disease]] who become hemodynamically unstable as a consequence of [[AF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


===Class III===
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]===
1. [[Theophylline]] and [[beta-adrenergic agonist]] agents are not recommended in patients with bronchospastic lung disease who develop [[AF]]. ''(Level of Evidence: C)''
'''1.''' [[Theophylline]] and [[beta-adrenergic agonist]] agents are not recommended in patients with bronchospastic lung disease who develop [[AF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


2. [[Beta blockers]], [[sotalol]], [[propafenone]], and [[adenosine]] are not recommended in patients with [[obstructive lung disease]] who develop [[AF]]. ''(Level of Evidence: C)''}}
'''2.''' [[Beta blockers]], [[sotalol]], [[propafenone]], and [[adenosine]] are not recommended in patients with [[obstructive lung disease]] who develop [[AF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}


==See Also==
==Vote on and Suggest Revisions to the Current Guidelines==
* [[The Living Guidelines: Diagnosis and Management of Atrial Fibrillation | The AF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]
* [[The Living Guidelines: Diagnosis and Management of Atrial Fibrillation | The AF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]


==Sources==
==Guideline Resources==
* The ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation <ref name="Fuster"> Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Le Heuzey JY, Kay GN, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann S. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation- Executive Summary: executive summary: 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 Guidlines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006; 114: 700-752. PMID 16908781 </ref>
*[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>
 
*[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>
 
*[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>


==References==
==References==
{{reflist|2}}
{{reflist|2}}
==Further Readings==
{{refbegin|2}}
* Fuster V, Rydén LE, Cannom DS, et al (2006). "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. doi:10.1161/CIRCULATIONAHA.106.177292. PMID 16908781.
* Estes NAM 3rd, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS, McNamara RL, Messer JV, Ritchie JL, Romeo SJW, Waldo AL, Wyse DG. ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with non valvular 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 Performance Measures for Atrial Fibrillation). Circulation 2008; 117:1101–1120
{{refend}}
{{Electrocardiography}}
{{Circulatory system pathology}}
{{SIB}}


[[Category:Electrophysiology]]
[[Category:Electrophysiology]]

Revision as of 18:57, 30 October 2011

Conduction
Sinus rhythm
Atrial fibrillation
'
ICD-10 I48
ICD-9 427.31
DiseasesDB 1065
MedlinePlus 000184

Atrial Fibrillation Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

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Differentiating Atrial Fibrillation from other Diseases

Epidemiology and Demographics

Risk Factors

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Postoperative AF
Acute Myocardial Infarction
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Atrial fibrillation pulmonary diseases On the Web

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.

Synonyms and related keywords: AF, Afib, fib

Overview

In patients with COPD, supraventricular arrhythmias, including atrial fibrillation are common.[1][2] In patients with acute exacerbations of COPD, the presence of AF has shown to have worst prognosis.[3] The first step in the management is to treat the underlying lung disease and correct hypoxia and acid-base imbalance. Theophylline and beta adrenergic agonists, which are commonly used to relieve bronchospasm, may precipitate atrial fibrillation. In patients with bronchospasm, beta blockers, sotalol, propafenone, and adenosine are contraindicated. Non-dihydropyridine calcium channel blocker and intravenous flecainide[4] may be used to restore sinus rhythm. However, in hemodynamically unstable patients direct-current cardioversion may be attempted. In patients refractory to drug therapy, AV nodal ablation and ventricular pacing may be necessary to control the ventricular rate.

ACCF/AHA/HRS 2011 Guidelines- Pulmonary Diseases (DO NOT EDIT) [5][6]

“

Class I

1. Correction of hypoxemia and acidosis is the recommended primary therapeutic measure for patients who develop AF during an acute pulmonary illness or exacerbation of chronic pulmonary disease. (Level of Evidence: C)

2. A non dihydropyridine calcium channel antagonist (diltiazem or verapamil) is recommended to control the ventricular rate in patients with obstructive pulmonary disease who develop AF. (Level of Evidence: C)

3. Direct-current cardioversion should be attempted in patients with pulmonary disease who become hemodynamically unstable as a consequence of AF. (Level of Evidence: C)

Class III

1. Theophylline and beta-adrenergic agonist agents are not recommended in patients with bronchospastic lung disease who develop AF. (Level of Evidence: C)

2. Beta blockers, sotalol, propafenone, and adenosine are not recommended in patients with obstructive lung disease who develop AF. (Level of Evidence: C)

”

Vote on and Suggest Revisions to the Current Guidelines

Guideline Resources

References

  1. ↑ Shih HT, Webb CR, Conway WA, Peterson E, Tilley B, Goldstein S (1988) Frequency and significance of cardiac arrhythmias in chronic obstructive lung disease. Chest 94 (1):44-8. PMID: 2454781
  2. ↑ Hudson LD, Kurt TL, Petty TL, Genton E (1973) Arrhythmias associated with acute respiratory failure in patients with chronic airway obstruction. Chest 63 (5):661-5. PMID: 4122207
  3. ↑ Fuso L, Incalzi RA, Pistelli R, Muzzolon R, Valente S, Pagliari G et al. (1995) Predicting mortality of patients hospitalized for acutely exacerbated chronic obstructive pulmonary disease. Am J Med 98 (3):272-7. PMID: 7872344
  4. ↑ Barranco F, Sanchez M, Rodriguez J, Guerrero M (1994) Efficacy of flecainide in patients with supraventricular arrhythmias and respiratory insufficiency. Intensive Care Med 20 (1):42-4. PMID: 8163757
  5. ↑ 5.0 5.1 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) 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. DOI:10.1161/CIRCULATIONAHA.106.177292 PMID: 16908781
  6. ↑ 6.0 6.1 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) 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. DOI:10.1161/CIR.0b013e318214876d PMID: 21382897
  7. ↑ Estes NA, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS et al. (2008) 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. DOI:10.1161/CIRCULATIONAHA.107.187192 PMID: 18283199

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