Paper Summary:

The paper discusses the causes and impact of an atrial fibrillation (AF) episode. The paper describes the symptoms of AF and then details the different treatments available. The paper also addresses the role of nurses as the primary care givers for these patients.

From the Paper:

"Atrial fibrillation represents the single most common form of cardiac arrhythmias and is identified in 5% of all people above the age of 69, affecting an estimated 2.2 million people in the US alone. [Lawrence Rosenthal, (2009)] It is a tachy arrhythmia with diverse triggers ('including sympathetic and parasympathetic stimulation') that initiate an episode and favorable substrates that maintain it. Currently, the exact causes that trigger an AF episode are not totally understood but multiple mechanisms are found to be in play. One such theory is the 'multiple wavelet theory' that suggests that the 'fractionalization of waves' that travel along the atrium leads to 'daughter wavelets' that results in multiple wavelet reentry. This theory proposes that the number of daughter wavelets maybe determined by different factors including the reduction in 'atrial conduction velocity', decreased 'atrial refractory period' and atrial mass. [Lawrence Rosenthal, (2009)] More recent studies have implicated ectopic sites in the pulmonary vein and the vena caval junctions as potential triggers of AF. This theory has been attested by cases of patients recovering after radio frequency ablation of the vena caval junctions. [Maurits et.al 2001]
"Typically, during an AF episode, the atrium may beat up to 300 times per minute while the ventricles may beat up to 175 times per minute . During AF, the conduction signal may originate in a different location of the atria (other than the usual SA node) or may be originating from the adjacent left pulmonary vein. This results in abnormal contractions of the atrium that significantly affects ventricular filling."

Sample of Sources Used:

• Maurits A. Allessie, MD, PhD & Penelope A. Boyden et.al (2001), 'Pathophysiology and Prevention of Atrial Fibrillation', Circulation. 2001;103:769 , Available Online at, http://www.circ.ahajournals.org/cgi/content/full/103/5/769
• NIH, 'Atrial Fibrillation', retrieved Sept 10th 2009, from http://www.nhlbi.nih.gov/health/dci/Diseases/af/af_what.html
• Vias Markides & Richard J Schilling, (2003) ,'Atrial Fibrillation, Classification, Pathophysiology, Mechanisms and Drug Treatment', Heart. 2003 August; 89(8): 939-943
• Josephson Linda & McMullen Maureen , (2003), 'Atrial Fibrillation: Beyond Irregularly irregular', Nursing 2003, Available online at, http://findarticles.com/p/articles/mi_qa3689/is_200301/ai_n9182958/
• Joan Della Rocco, 'Responding to Atrial Fibrillation', Nursing April 2007, Available Online at, http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=707110

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