Rhythm of the Month - March 2011
| 
| 
This rhythm is the most common abnormal rhythm seen in the population at large. It has potentially serious complications if not diagnosed and treated early. Most of you will be able to tell what the rhythm is by just this information. But…can you recognize the rhythm and differentiate it from other rhythms, say Atrial Flutter, if you see the two rhythms side by side? My many years of teaching cardiac rhythms have taught me these two rhythms are the most difficult for folks to learn and differentiate. All three strips shown here are the same rhythm, but with different rates.
If you think this months’ Rhythm of the Month is Atrial Fibrillation (also known as A-Fib), then you are absolutely right. Congratulations! For those of you that are not quite sure or don’t know, let’s take a closer look.
The Mechanism: The two upper chambers, the atria, beat chaotically and irregularly, out of synch with the two lower chambers, the ventricles. The rhythm for the ventricles is what we call irregularly irregular. With this pattern the whole rhythm is irregular. The atrial rhythm at the baseline is wavy, unorganized, and chaotic with no organized P waves as we know them associated with the QRSs. The ventricular rhythm will always be irregular and the QRS complex can be either narrow or wide. There is no P to P / R to R association. No PRIs are measurable.
Potential Complications: Because the atria are not pumping in an organized, effective manner, the atrial kick is lost, decreasing the total cardiac output by as much a 15% to 20%. Many patients will experience symptoms with the loss of the atrial kick. Formation of emboli behind the valve leaflets could break off leading to complications such as stroke, pulmonary embolus, deep vein thrombosis, or heart attack.
This rhythm in itself is usually not life threatening, but it is considered a serious rhythm. Its recognition and treatment should be initiated early, especially if the patient is symptomatic.
Possible Treatment: If onsetof this rhythm is less than 48 hours, synchronized cardioversion may be attempted. If onset occurred more than 48 hours prior to seeking treatment, then anticoagulants are initiated. Other treatments may include: chemical cardioversion with medications, Catheter Radiofrequency Ablation, Pacemaker and Mini Maze Procedure.
Interpretation: Atrial Fibrillation 
