Atrial Fibrillation (A Fib) or (AF)

Atrial Fibrillation


A cardiac arrhythmia characterized by disorganized electrical activity in the atria accompanied by an irregular ventricular response that is usually rapid. The atria quiver instead of pumping in an organized fashion, resulting in compromised ventricular filling and reduced stroke volume. Stasis of left atrial flow increases the risk of stroke as a result of clot formation. AF is associated with hypertension, diabetes, age, rheumatic heart disease (left atrial dilation), mitral stenosis, acute myocardial infarction, and heart surgery, or it may be idiopathic (lone AF). Treatment goals are to control the ventricular rate by creating atrioventricular block, to prevent stroke through the use of anticoagulants, and to convert to sinus rhythm. Treatment categories include paroxysmal, persistent, and chronic. AF is called controlled if ventricular response is less than 100. If ventricular response is 100 or more, it is called uncontrolled atrial fibrillation. 


Characteristics

Rate Atrial rate 400-600 BPM, Ventricular rate variable


Rhythm Ventricular irregularly irregular 

P-Waves No identifiable P waves, Fibrillatory waves are present. Erratic wavy baseline


PR Interval Not measurable.


QRS Duration 0.11 sec (2 1⁄2 small boxes) or less, but may be widened if the flutter waves are buried in the QRS complex


MEDS

Stable Symptomatic with Rapid Ventricular Rate
 Administer Diltiazem .25mg/kg SIVP


Treatment

(Best to consult cardiologist prior to treatment)



Stable Symptomatic with Rapid Ventricular Rate 

Monitor Diagnostic 12 lead

Oxygen 15 LPM NR Mask


IV 18g

Administer Meds
 Diltiazem .25mg/kg SIVP



Serious Signs and Symptoms with Rapid Ventricular Rate.

Consider Synchronized Cardioversion.


Noticeable by: 

The QRS are irregular and unidentifiable P Waves. 

© Matt Dillard 2012