Atrial fibrillation overview
| Conduction | ||
Sinus rhythm  |
Atrial fibrillation  | |
| Atrial fibrillation | |
 | |
|---|---|
| The P waves, which represent depolarization of the atria, are irregular or absent during atrial fibrillation. | |
| ICD-10 | I48 |
| ICD-9 | 427.31 |
| DiseasesDB | 1065 |
| MedlinePlus | 000184 |
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Synonyms and related keywords: AF, Afib, fib
Overview of Atrial Fibrillation
Atrial fibrillation (AF or afib) is a cardiac arrhythmia (abnormal heart rhythm) that involves the two upper chambers (atria) of the heart.Atrial fibrillation is an irregularly irregular heart beat due to chaotic firing of the impulses in the atrium. In this rhythm the atrium is stimulated chaotically by a wide number of ectopic foci of electrical activity. Due to the lack of coordination of atrial activation, there is a decline in the mechanical pumping action of the atrium. [1]The decline in mechanical function of the atrium may or may not lead to inadequate filling of the ventricle depending upon the importance of the atrial "kick" or atrial contribution to ventricular filling in a given patient.) It can often be identified by taking a pulse and observing that the heartbeats don't occur at regular intervals, but a conclusive indication of AF is the absence of P waves on an electrocardiogram (ECG). AF is the most common arrhythmia; risk increases with age, with 8% of people over 80 having AF. In AF, the normal electrical impulses that are generated by the sinoatrial node are overwhelmed by disorganized electrical impulses that originate in the atria and pulmonary veins, leading to conduction of irregular impulses to the ventricles that generate the heartbeat. The result is an irregular heartbeat which may occur in episodes lasting from minutes to weeks, or it could occur all the time for years. The natural tendency of AF is to become a chronic condition. Chronic AF leads to a small increase in the risk of death.[2][3]
Atrial fibrillation is often asymptomatic, and is not in itself generally life-threatening, but may result in palpitations, fainting, chest pain, or congestive heart failure. Patients with AF usually have a significantly increased risk of stroke (up to 7 times that of the general population). Stroke risk increases during AF because blood may pool and form clots in the poorly contracting atria and especially in the left atrial appendage (LAA). The level of increased risk of stroke depends on the number of additional risk factors. If the AF patient has none, the risk of stroke is similar to that of the general population.[4] However, many patients do have additional risk factors and AF is a leading cause of stroke.[5]
The result of this process is an irregular heartbeat. This may be continuous (persistent or permanent AF) or alternating between periods of a normal heart rhythm (paroxysmal AF). The natural tendency of atrial fibrillation is to become a chronic condition.
Atrial fibrillation may be treated with medications which either slow the heart rate or revert the heart rhythm back to normal. Synchronized electrical cardioversion may also be used to convert AF to a normal heart rhythm. Surgical and catheter-based therapies may also be used to prevent recurrence of AF in certain individuals. People with AF are often given anticoagulants such as warfarin to protect them from stroke.
Among patients in whom there is normal atrioventricular conduction, fibrillatory or irregular impulses that vary in timing, amplitude and shape are present which are in turn associated with the rapid irregular ventricular response that characterizes atrial fibrillation. [6][7]
Historical Background
Because the diagnosis of atrial fibrillation requires measurement of the electrical activity of the heart, it was not truly described until 1874, when Edmé Félix Alfred Vulpian observed the irregular atrial electrical behavior that he termed "fremissement fibrillaire" in dog hearts.[8]
In the mid-eighteenth century, Jean-Baptiste de Sénac made note of dilated, irritated atria in people with mitral stenosis.[9] The irregular pulse associated with AF was first recorded in 1876 by Carl Wilhelm Hermann Nothnagel and termed "delirium cordis", stating that "In this form of arrhythmia the heartbeats follow each other in complete irregularity.
At the same time, the height and tension of the individual pulse waves are continuously changing".[10] Correlation of delirium cordis with the loss of atrial contraction as reflected in the loss of a waves in the jugular venous pulse was made by Sir James MacKenzie in 1904.[11]
Willem Einthoven published the first electrocardiogram showing AF in 1906.[12]
The connection between the anatomic and electrical manifestations of AF and the irregular pulse was made in 1909 by Carl Julius Rothberger, Heinrich Winterberg, and Sir Thomas Lewis.[13][14][15]
See Also
References
- ↑ Fuster V, Rydén LE, Asinger RW; et al. (2001). "ACC/AHA/ESC 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 and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology". Eur. Heart J. 22 (20): 1852–923. doi:10.1053/euhj.2001.2983. PMID 11601835. Unknown parameter
|month=ignored (help) - ↑ Benjamin EJ, Wolf PA, D'Agostino RB, Silbershatz H, Kannel WB, Levy D (1998). "Impact of atrial fibrillation on the risk of death: the Framingham Heart Study". Circulation. 98 (10): 946–52. PMID 9737513.
- ↑ Wattigney WA, Mensah GA, Croft JB (2002). "Increased atrial fibrillation mortality: United States, 1980-1998". Am. J. Epidemiol. 155 (9): 819–26. doi:10.1093/aje/155.9.819. PMID 11978585.
- ↑ Jahangir A, Lee V, Friedman PA, Trusty JM, Hodge DO, Kopecky SL, Packer DL, Hammill SC, Shen WK, Gersh BJ (2007). "Long-term progression and outcomes with aging in patients with lone atrial fibrillation: a 30-year follow-up study". Circulation. 115 (24): 3050–6. doi:10.1161/CIRCULATIONAHA.106.644484. PMID 17548732.
- ↑ Wolf PA, Dawber TR, Thomas HE, Kannel WB (1978). "Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study". Neurology. 28 (10): 973–7. PMID 570666.
- ↑ Bellet S. Clinical Disorders of the Heart Beat. 3rd ed. Philadelphia: Lea& Febiger, 1971
- ↑ 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. Unknown parameter
|month=ignored (help) - ↑ Vulpian A. (1874). Note sur les effets de la faradisation directe des ventricules du coeur chez le chien. Archives de Physiologie Normale et Pathologique 6:975.
- ↑ McMichael J. (1982). History of atrial fibrillation 1628-1819 Harvey-de Senac-Laennec. Br Heart J 48: 193-7. PMID 7049202.
- ↑ Nothnagel H. (1876). Ueber arythmische Herzthatigkeit. Deutsches Archiv fur Klinische Medizin 17: 190-220.
- ↑ MacKenzie J. (1904). The inception of the rhythm of the heart by the ventricle. Br Med J 1: 529-36.
- ↑ Einthoven W. (1906). Le telecardiogramme. Archives Internationales de Physiologie 4: 132-64.
- ↑ Rothberger CJ, Winterberg H. (1909). Vorhofflimmern und Arhythmia perpetua. Wiener Klinische Wochenschrift 22: 839-44
- ↑ Lewis T (1909). Auricular fibrillation: a common clinical condition. Br Med J 2: 1528
- ↑ Flegel KM (1995). "From delirium cordis to atrial fibrillation: historical development of a disease concept". Ann. Intern. Med. 122 (11): 867–73. PMID 7741373.
Further Readings
- 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
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