Patient with SVT

"Patient with HR 160"

Narrow

• on boards, HR > 150, regular

• on boards, HR < 150, IRR

• Chaotic baseline, sawtooth

aFib

A Fib Risk Factors

• Age
  • ~ 10% of patients > 80
  • < 1% patients < 55
• F > M
• Associated with HTN, CAD
• Anything that dilates atria
  • HF
  • Valvular disease
• Dx structure abnormality with echo
• Pts with hyperthyroidism
  • New aFib should have TSH levels

A Fib triggers

• Often no trigger identified
• Binge drinking
• Increased catecholamines
  • Infection
  • Surgery
  • Pain

A Fib Tx

• Rate control
  • HR < 110
    • BB
      • B1 selective (metoprolol, Atenolol)
    • Ca Blocker
      • Verapamil, diltiazem
    • Digoxin (increases parasympathetic tone)
• Rhythm control
  • Electrical
  • Chemical
    • Ibutilide (class III)
  • Spontaneous
    • Common when d/t infection
• Anticoagulation

Cardioversion

• Risk of stroke
• Data that 48 hours for thrombus formation
• If sxs > 48 hours, anticoagulate and wait 3 weeks
• Exception: hypotension/shock

Anticoagulation

• Likely anticoagulate pts who develop aFib
• Even if sinus rhythm restored
• CHADS VASC Score

Pulomonary vein isolation

Atrial Flutter

Atrial Flutter

• Very similar to aFib
• Can be asymptomatic
• tx the same way
• aFlutter ablation

Thank You!