Atrial Fibrillation
Original Editors - Students from Bellarmine University's Pathophysiology of Complex Patient Problems project.
Top Contributors - Paul McDermott, James Moore, Lucinda hampton, Kim Jackson, Adam Vallely Farrell, Elaine Lonnemann, George Prudden, WikiSysop, Karen Wilson and Vidya Acharya
Definition/Description[edit | edit source]
Atrial fibrillation (AF), is the most common type of arrhythmia During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm.
AF occurs when rapid disorganized electrical signals cause the heart's two upper chambers- the atria to fibrillate. “Fibrillate" means that the heart muscle is not making full contractions. Instead, the cardiac muscle in the atria is quivering at a rapid and irregular pace.
Due to the atrial fibrillations, blood pools in the atria as it is not completely pumped out of the atria into the two lower chambers known as the ventricles.
People who have AF may not feel symptoms. In some individuals AF can cause chest pain,(MORE SYMPTOMS FOR THE LAY PERSON HERE)*** heart failure, and can increase the risk of stroke.1
Atrial Fibrillations can occur independently or may be associated with underlying causes. It can manifest itself suddenly as in paroxysmal AF which terminates spontaneously or with intervention within 7 days of onset. AF not associated with an underlying cause is known as lone AF.
AF sustained longer than seven days is known as persistent AF. When it occurs continuously for longer than twelve months it is known as long-standing persistent AF.
The term permanent AF is used when the patient and clinician make a joint decision to stop further attempts to restore and/or maintain sinus rhythm. Acceptance of AF represents a therapeutic attitude on the part of the patient and clinician rather than an inherent pathophysiological attribute of AF. Acceptance of AF may change as symptoms, efficacy of therapeutic interventions, and patient and clinician preferences evolve
Nonvalvular AF is a term used to describe when there is the absence of rheumatic mitral stenosis, a mechanical or bioprosthetic heart valve, or mitral valve repair. 2
Prevalence[edit | edit source]
Atrial fibrillation (AF) is a cardiac arrhythmia associated with significant morbidity and mortality, affecting more than 3 million people in the United States and 1-2% of the population worldwide. Its estimated prevalence is expected to double within the next 50 years
AF without associated heart disease: Approximately 30% to 45% of cases of paroxysmal AF and 20% to 25% of cases of persistent AF occur in young patients without demonstrable underlying disease. This is considered lone AF. Although, over the course of time, an underlying, causal disease may appear.3
AF may occur in the elderly without underlying heart disease as well. However changes in cardiac structure and function that accompany the aging process, such as increased myocardial stiffness, may be associated with AF.4
AF with associated heart disease: Specific cardiovascular conditions associated with AF include valvular heart disease (most often mitral valve disease), HF, coronary artery disease (CAD), and hypertension, particularly when LV hypertrophy (LVH) is present. In addition, AF may be associated with HCM, dilated cardiomyopathy, or congenital heart disease, especially atrial septal defect in adults. Potential etiologies also include restrictive cardiomyopathies (e.g., amyloidosis, hemochromatosis, and endomyocardial fibrosis), cardiac tumors, and constrictive pericarditis. Other heart diseases, such as mitral valve prolapse with or without mitral regurgitation, calcification of the mitral annulus, cor pulmonale, and idiopathic dilation of the right atrium, have been associated with a high incidence of atrial fibrillation.4
Familial associated AF:
Familial AF, defined as lone AF running in a family, is more common than previously recognized but should be distinguished from AF secondary to other genetic diseases like familial cardiomyopathies. The likelihood of developing AF is increased among the offspring of parents with AF, suggesting a familial susceptibility to the arrhythmia, but the mechanisms associated with transmission are not necessarily electrical, because the relationship has also been seen in patients with a family history of hypertension, diabetes, or HF.4
Autonomic Influence in AF:
In general, vagally mediated AF occurs at night or after meals, while adrenergically induced AF typically occurs during the daytime. Beta blockers are initial drug of choice for adrenergic dominated AF.4
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