Identified as electrical chaos; it is a from
of unpatterned depolarization of atrial tissues caused by multiple micro reentry circuits.
ECG findings: absent P waves, fibrillatory waves, and irregularly irregular QRS complexes.
May manifests as palpitations, dyspnoea, angina, dizziness, syncope, and/or features of congestive heart failure, stroke, and death.
Coronary artery disease.
Rheumatic heart disease.
Relieve the patient's symptoms.
Reduce HR < 120 bpm.
Retain sinus rhythm (SR), if possible.
in younger patients; < 65 y/o with new-onset AF, starting with cardioversion is preferred to retain SR.
Using antiarrhythmic as an adjunct therapy to rate controllers may help to retain normal SR.
If diuretics and vasodilators failed to reduce HR in decompensated HFrEF, antiarrhythmic is indicated.
Pretreatment with antiarrhythmics increases the success rate of electrical cardioversion and reduces the risk of recurrence.
Anticoagulation coverage (INR= 2-3) for 3-4 weeks is conditional to start electrical cardioversion.
Contraindications for cardioversion:
- More than 48 hours of onset or unknown onset. DC
- Structural heart diseases. Antiarrythmics
- Recent stroke, TIA. Relative CI
- Atrial clot, or INR < 2. Absolute CI
- Severe hypomagnesemia, hypokalemia, digoxin toxicity. Absolute CI for antiarrhythmics.