COMMON CARDIAC ARRHYTHMIAS 2the complex arrhythmias

COMMON CARDIAC ARRHYTHMIAS 2the complex arrhythmias

Mark Earley, St Bartholomew’s Hospital

Atrial Fibrillation (AF)Atrial Fibrillation (AF)

Paroxysmal AFParoxysmal AF

AF – modern terminologyAF – modern terminology

FIRST EPISODE of AF

RECURRENT EPISODE of AF

PAROXYSMAL AF PERSISTENT AF

PERMANENT AF SINUS RHYTHM

AF - aetiologyAF - aetiology

AF – mechanism - chaosAF – mechanism - chaos

Mechanism of AF: focal v re-entryMechanism of AF: focal v re-entry

FOCAL RE-ENTRY (Circus movement)

1959-1964 Moe’s Hypothesis multiple random re-entry wavefronts

Mechanism - focal

Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. NEJM 1998; 339:659-66

Mechanism of AFMechanism of AF

Focal ‘triggers’

Multiple wavefronts

Mechanism of AFMechanism of AF

PAROXYSMAL

PERSISTENT

PERMANENT

Preexcited AFPreexcited AF