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
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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
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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)
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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
*>2mm STTreadmill ( ind.
*BP
segment dep/elev
ramp protocol, 8*RPE
*ischemic
12 min target.
*Angina scale
threshold
Moderately
*Gas analysis (VO2 *T- wave inversion
incremented
peak)
with st change
protocol<1MET/2- *Radionuclide
*SBP > 250 mmhg
3 min
*testing
or DBP >115
(naughton/balke)
mmhg
*3+ on angina
Better estimate of
scale
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 can cause stroke
http://www.youtube.com/user/boeh
ringeringelheim?v=eb1nLeQiWOM
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
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May control ventricular response; diffuse ST effects
 Calcium channel blockers
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May mask ischemia and decrease exercise heart rate response
 Diltiazem, verapamil
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Help control ventricular response; may improve exercise capacity
 Beta blockers
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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
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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 VO2 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% VO2 peak
or HR reserve
*3-7 days/week
*30-45 min/session
3 Months
*High reps, low
resistance (1215reps)
*2-3
nonconsecutive
days/week
2-3 Months
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
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prescription, 8th 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/health-topics/topics/af/
Youtube video on atrial fibrillation and stroke:
http://www.youtube.com/user/boehringeringelheim?v=eb1nLeQi
WOM
Youtube video on electrical cardioversion:
http://heart.emedtv.com/electrical-cardioversion-video/whathappens-during-electrical-cardioversion-video.html
Questions