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.
If monotherapy was not adequate, use dual therapy to control the heart rate.
Caution: both groups of medications may cause severe bradycardia, heart block, asystole, heart failure, or hypotension.
Continue heart rate control until you establish successful cardioversion.
CCBs are preferred in patients with chronic lung disease where bronchospasm may occur with beta-blockers.
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; for DC.
Structural heart diseases; for antiarrhythmic.
Recent stroke, TIA; relative CI.
Atrial clot, or INR < 2; absolute CI.
Severe hypomagnesemia, hypokalemia, digoxin toxicity. Absolute CI for antiarrhythmics.