{"id":207,"date":"2018-10-22T19:09:30","date_gmt":"2018-10-22T19:09:30","guid":{"rendered":"https:\/\/www.proacls.com\/wiki\/?p=207"},"modified":"2018-12-12T23:00:44","modified_gmt":"2018-12-12T23:00:44","slug":"atrial-fibrillation","status":"publish","type":"post","link":"https:\/\/www.proacls.com\/wiki\/ekg-rhythms\/atrial-fibrillation\/","title":{"rendered":"Atrial Fibrillation"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/E2Ro8xDQjuw\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>There are three primary types of atrial fibrillation:<\/p>\n<ul>\n<li>Paroxysmal Atrial Fibrillation\n<ul>\n<li>Transient episodes that stop on their own<\/li>\n<li>May last anywhere from seconds or minutes, to hours or up to a week<\/li>\n<\/ul>\n<\/li>\n<li>Persistent Atrial Fibrillation\n<ul>\n<li>Episodes last more than a week<\/li>\n<li>Episodes that last less than a week but are only stopped by either pharmacological or electrical cardioversion<\/li>\n<\/ul>\n<\/li>\n<li>Long-Standing Persistent Atrial Fibrillation\n<ul>\n<li>Persistent atrial fibrillation that lasts longer than one year<\/li>\n<li>Formerly known as chronic or permanent atrial fibrillation<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>Atrial fibrillation is when multiple electrical impulses are being generated in the atria at the same time. This causes chaotic myocardial responses that may diminish both the pre-load and effectiveness of the cardiac contraction.<\/p>\n<p>This can lead to:<\/p>\n<ul>\n<li>Development of microemboli due to stagnant blood flow from the atria<\/li>\n<li>Rapid ventricular response secondary to a reentry problem<\/li>\n<\/ul>\n<p>The electrical pattern will have no discernable P waves. \u00a0Instead, it will have a fibrillatory wave between each QRS complex. The result is a lack of coordinated electrical impulses from the atria with an irregular ventricular response.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-416\" src=\"https:\/\/www.proacls.com\/wiki\/wp-content\/uploads\/2018\/10\/afib-ecg.jpg\" alt=\"Atrial Fibrillation ECG\" width=\"1500\" height=\"676\" \/><\/p>\n<h2>To interpret an ECG, ask the following questions:<\/h2>\n<h3>Rhythm<\/h3>\n<ul>\n<li>Is the rhythm regular or irregular?\n<ul>\n<li><i>The rhythm is irregular<\/i><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h3>Rate<\/h3>\n<ul>\n<li>What is the rate?\n<ul>\n<li><i>The rate is 80 bpm, but irregular<\/i><\/li>\n<\/ul>\n<\/li>\n<li>Is the rate normal, fast or slow?\n<ul>\n<li><i>The rate is variable because of its irregularity<\/i><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h3>P Waves<\/h3>\n<ul>\n<li>Are they present?\n<ul>\n<li><i>No, the P waves are not present<\/i><\/li>\n<\/ul>\n<\/li>\n<li>Do they occur regularly?\n<ul>\n<li><i>No, because there are no P waves<\/i><\/li>\n<\/ul>\n<\/li>\n<li>Is there one P wave for each QRS complex?\n<ul>\n<li><i>No<\/i><\/li>\n<\/ul>\n<\/li>\n<li>Are the P waves smooth, rounded, and upright?\n<ul>\n<li><i>No<\/i><\/li>\n<\/ul>\n<\/li>\n<li>Do all P waves have similar shapes?\n<ul>\n<li><i>No<\/i><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h3>PR Interval<\/h3>\n<ul>\n<li>Does the PR interval fall within the normal 0.12-0.20 seconds?\n<ul>\n<li><i>No, because there isn\u2019t a PR interval<\/i><\/li>\n<\/ul>\n<\/li>\n<li>Is the PR interval constant?\n<ul>\n<li><i>This doesn\u2019t apply because there is not a P wave<\/i><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h3>QRS<\/h3>\n<ul>\n<li>Is the QRS interval less than 0.09 seconds?\n<ul>\n<li><i>Yes, the QRS is within normal range<\/i><\/li>\n<\/ul>\n<\/li>\n<li>Is the QRS wide or narrow?\n<ul>\n<li><i>In this case, the QRS is narrow<\/i><\/li>\n<\/ul>\n<\/li>\n<li>Are the QRS complexes similar in appearance?\n<ul>\n<li><i>Each one looks similar<\/i><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h3>Cardiac Interpretation<\/h3>\n<p>This ECG would indicate atrial fibrillation. There are many possible causes, some of the most common underlying ones are:<\/p>\n<ul>\n<li>CHF patients or those with a previous history where the patient may have damage to the SA node<\/li>\n<li>Patient has a conduction system dysfunction from a current or past MI<\/li>\n<li>Patient has experienced a traumatic injury<\/li>\n<li>Patient has a disease process<\/li>\n<li>Patient may have used or still uses harmful drugs<\/li>\n<li>Patient has a metabolic disorder<\/li>\n<\/ul>\n<p>Common side effects from atrial fibrillation include, but are not limited to:<\/p>\n<ul>\n<li>A higher risk for coronary, cerebral, or pulmonary embolism\n<ul>\n<li>A result of the increased potential for microemboli to develop secondary to the lack of circulation of blood from the atria<\/li>\n<\/ul>\n<\/li>\n<li>Rapid ventricular response to the atrial fibrillation which can accelerate the ventricular rate to above 100 bpm\n<ul>\n<li>Atrial Fibrillation combined with higher ventricular rates may decrease the amount of blood ejected from the heart due to the lack of the preloading Atrial Kick.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>There are three primary types of atrial fibrillation: Paroxysmal Atrial Fibrillation Transient episodes that stop on their own May last anywhere from seconds or minutes, to hours or up to a week Persistent Atrial Fibrillation Episodes last more than a week Episodes that last less than a week but are only stopped by either pharmacological [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[10],"tags":[],"class_list":["post-207","post","type-post","status-publish","format-standard","hentry","category-ekg-rhythms"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - 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