Atrial Fibrillation RACHEL KITCHEN Overview Definition and epidemiology

Atrial Fibrillation RACHEL KITCHEN

Overview �Definition and epidemiology �Symptoms �Tests/Evaluations �Complications �Treatment �Effects on exercise �Medications effect on exercise �Effects of training �Exercise prescription

Definition �Rapid unorganized electrical impulses (not coming from the sinus node-thus not sinus rhythm) cause the atria to squeeze in a rapid and unorganized manner. This is called fibrillation. �Often referred to as a-fib �Most common type of arrhythmia �Affects millions of people �Men are more likely to have than women �Risk increases as you age �Uncommon in children

Definition �Paroxysmal atrial fibrillation Begins suddenly and stops on its own. Usually stops and starts whithin 24 hours to a week. �Persistent atrial fibrillation May start and stop on its own or with treatment. Usually lasts more than a week. �Permanent atrial fibrillation Atrial fibrillation persists and the normal heart rhythm cannot be brought back with treatment.

Normal Sinus Rhythm vs. Atrial Fibrillation

Doctors involved �Primary care doctor (family practitioners and internists �Cardiologist �Electrophysiologist (Cardiologist who specializes in arrhythmias)

Signs and Symptoms �Palpitations/Irregular beats/Skipped beats �Shortness of breath �Weakness or problems exercising �Chest pain �Fatigue �Confusion

Risk Factors � High blood pressure � Coronary heart disease (CHD) � Heart failure � Rheumatic heart disease � Mitral valve prolapse � Pericarditis � Congenital heart defects � Sick sinus syndrome � Post heart attack or surgery � Obesity � Diabetes � Drinking large amounts of alcohol

Laboratory Diagnosis � Ambulatory telemetry monitor (ATM) (1 -30 day monitoring at home) Patient presses a symptoms button when having symptoms If asymptomatic, monitor will catch any abnormalities. If atrial fibrillation is found or other serious arrhythmia the doctor will be notified This is a newer and very effective way to diagnose and catch atrial fibrillation � Holter monitor (24 hours monitoring at home) � EKG (10 second strip) � Stress tests � Echocardiography � Transesophageal Echocariography (TEE) � Chest X-ray � Blood tests

Tests Methods Measures Endpoints Comments Aerobic Cycle *Serious *12 -lead ECG, HR dysrhythmias *>2 mm STTreadmill ( ind. *BP segment dep/elev ramp protocol, 8*RPE *ischemic 12 min target. *Angina scale threshold Moderately *Gas analysis (VO 2 *T- wave inversion incremented peak) with st change protocol<1 MET/2 - *Radionuclide *SBP > 250 mmhg 3 min *testing or DBP >115 mmhg (naughton/balke) *3+ on angina scale Better estimate of exercise capacity Endurance 6 min walk Distance walked Flexibility Goniometry Angle of flexion/extension Rest stops allowed If lowered ROM

Complications �Two major complications /Heart failure and stroke �Heart failure Heart can’t pump blood sufficiently to the body. The ventricles are pumping really fast to get the blood to the body, but because they don’t completely fill with blood, they may not be able to get enough blood to the lungs and body Black legs Fatigue and SOB are common symptoms. Buildup of fluid in the lungs, feet, ankles, and legs causing weight gain. Important to weigh patient. If gaining lots of weight ask if they are retaining fluid

Complications �Stroke Because atria may not be pumping all the blood out. It can pool and form clots. If the atria pumps a clot through, it can travel to the brain and cause a stoke Some individuals who are asymptomatic with atrial fibrillation will have a stroke first then be diagnosed late

Atrial fibrillation cause stroke http: //www. youtube. com/user/boeh ringelheim? v=eb 1 n. Le. Qi. WOM

Treatment: Medical and Surgical �Medicines Blood clot prevention: Coumadin, heparin, warfarin(84% reduction in stroke risk), and aspirin (aspirin is less effective than warfarin) Rate control: Beta blockers(metoprolol and atenolol) calcium channel blockers(diltiazem and verapamil) and digitalis (digoxin) Rhythm control: Amiodarone, sotalol, flecainide, propafenone, dofetilide, and ibutilide. �Electrical cardioversion http: //heart. emedtv. com/electrical-cardioversion-video/whathappens-during-electrical-cardioversion-video. html

Treatment: Medical and Surgical �Catheter ablation: Wire is inserted through a vein in the arm or leg up to the heart. Radio wave energy is sent through to destroy bad tissue that is disrupting the normal electrical flow Sometime they will destroy the AV node and put in a pacemaker. The pacemaker will help to maintain a normal rhythm �Maze surgery: Requires open heart surgery. They make small cuts or burns in the atria. This helps to prevent the spread of disorganized or disobedient electrical signals

Effects of Disease on Ability to Exercise �Insufficient scientific literature is available about exercise training and atrial fibrillation �They would not have a significantly different response than a normal sinus rhythm individual. However, the medication they are on will have an influence on exercise �The major concern is underlying problems like heart disease, valvular disease, heart failure, and CAD �These underlying conditions should be the most important in considering exercise training

Effects of Medications on Ability to Exercise �Digoxin May control ventricular response; diffuse ST effects �Calcium channel blockers May mask ischemia and decrease exercise heart rate response �Diltiazem, verapamil Help control ventricular response; may improve exercise capacity �Beta blockers Help control ventricular response; may reduce exercise capacity. Decrease submaximal and maximal HR and BP response; sometimes exercise capacity, especially with nonselective medications �Things to consider Age-predicted max HR targets ARE NOT VALID Irregular ventricular response may make BP values less precise or more difficult to get

Exercise Programming Modes Goals Aerobic *Large muscles *Increase VO 2 peak activities *Increase ADLs *Arm/leg ergometry Resistance Weight machines Increase strength Flexibility Upper and lower *Increased body ROM activities felxibility *Reduce risk of injury Intensity/Freque ncy, Duration Time to goal *RPE 11 -16/20 *50 -80% VO 2 peak or HR reserve *3 -7 days/week *30 -45 min/session 3 Months *High reps, low 2 -3 Months resistance (1215 reps) *2 -3 nonconsecutive days/week 3 -5 days/week 2 -4 Months

Summary �Atrial fibrillation is most common type of arrhythmia �Can cause stroke or heart failure �Some can be treated for atrial fibrillation others can live with it �Individuals who have atrial fibrillation can exercise, focus on underlying conditions �Medications can have effect on assessment during exercise

References � ACSM. 2010. ACSM’s guidelines for exercise testing and prescription, 8 th ed. Baltimore: Lippincott Williams and Wilkens, chapter 5. � American Heart Association. 2010. Cardiovacular Statistics. http: /. www. american heart, org/ � Durstine, J. L et al. , editors. Exercise management for persons with chronis diseases and disabilities. Champaign, IL: Chapter 9. � National Heart Lung and Blood Institute. (2001). What is atrial fibrillation? http: //nhlbi. nih. gov/health-topics/af/ � Youtube video on atrial fibrillation and stroke: http: //www. youtube. com/user/boehringelheim? v=eb 1 n. Le. Qi. W OM � Youtube video on electrical cardioversion: http: //heart. emedtv. com/electrical-cardioversion-video/whathappens-during-electrical-cardioversion-video. html

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