Get certified in PALS for just $195.00.
To view this video please enable JavaScript, and consider upgrading to a web browser that supports HTML5 video
Now let's take a look at atrial fibrillation. There are three primary types of atrial fibrillation. Transient AFib stops on its own, and may last anywhere from seconds or minutes, to hours and even up to a week. Then we have persistent atrial fibrillation, which is defined episodes which last more than a week, or episodes that are only stopped by either pharmacological or electrical cardioversion. And lastly, there is long-standing persistent atrial fibrillation, which is a type of Persistent AFib that lasts longer than one year. Formerly, it may have been called chronic or permanent atrial fibrillation. The nature of atrial fibrillation is where multiple electrical impulses are being generated in the atria at the same time, and therefore cause chaotic myocardial responses, and they may diminish the pre-load and effectiveness of the cardiac contraction. This action may cause the development of microemboli due to the stagnant blood flow from the atria, and in some cases, this even leads to a rapid ventricular response, secondary to a re-entry problem. The electrical pattern will have no discernible P waves, but instead, it shows a fibrillatory wave between each QRS complex. Now, because there's a lack of coordinated electrical impulses generated from the atria traveling through the AV node and to the ventricles, the result is usually an irregular ventricular response which also occurs irregularly. So now, let's take a look at the ECG for AFib. We look at the rhythm, is the rhythm regular or irregular? And in this case, the rhythm is irregular. Next, we look at the rate, what is the rate? The rate is 80 beats per minute, but irregular. Is the rate normal, fast or slow? Well in this case, the rate is variable because it's irregular. Then we look at the P wave, are they present? And no, the P waves are not present. Do they occur regularly? And we would have to say no, because there are no P waves. Is there one P wave for each QRS complex? Again the answer would be no, there is no P wave for each QRS complex. And of course, are the P waves smooth, rounded, and upright? No, only fibrillatory waves exist. And lastly, do all P waves have similar shapes? But again, in this case, no. So then we move to the PR interval. Is the PR interval normal, less than 0.20 seconds? No, because there isn't a PR interval. And then again, is the PR interval constant? But this doesn't apply because there isn't a P wave. So now we move on to the QRS. Is the QRS interval less than 0.09 seconds? The answer is yes, the QRS is within normal range. And is the QRS wide or narrow? And in this case, the QRS is narrow. Are the QRS complexes similar in appearance? Here we can see that each one looks similar. So here is my cardiac interpretation based on this ECG. The ECG clearly shows that this patient has AFib. It's quite rare in children but can occur in children with cardiomyopathy and after complex heart surgery, and very rarely, in children with otherwise normal hearts. Expert consultation will be required to properly treat a child with atrial fibrillation.
Atrial fibrillation (also called AFib or AF) is a quivering or irregular heartbeat (arrhythmia) that can lead to blood clots, stroke, heart failure, and other heart-related complications.
In this lesson, we'll look at the three types of atrial fibrillation and then look at a typical ECG readout for a patient in AFib and provide a cardiac interpretation at the end.
Transient atrial fibrillation is defined by the following:
Persistent atrial fibrillation is defined by the following:
Long-standing persistent atrial fibrillation, formerly known as chronic or permanent atrial fibrillation, is defined as episodes that last longer than a year.
Atrial fibrillation occurs when multiple electrical impulses are being generated in the atria and at the same time, which causes chaotic myocardia responses.
AFib can diminish the preload and effectiveness of the cardiac contractions. This action could then cause the development of microemboli due to stagnant blood flow from the atria. In certain instances, this will even lead to a rapid ventricular response that's secondary to a reentry problem.
Pro Tip #1: The electrical pattern on an ECG will have no discernible P-waves, but instead, will show fibrillatory waves between each QRS complex. And because there's a lack of coordinated electrical impulses generated from the atria traveling through the AV node into the ventricles, the result is usually an irregular ventricular response, which also occurs irregularly.
Now let's take a look at an ECG for a patient in atrial fibrillation.
*Atrial Fibrillation ECG
The first thing you'll want to look at is the heart rhythm. Does the heart rhythm look regular? Or does it look irregular? In the ECG above, the rhythm is irregular.
Next, you'll want to look at the heart rate of the patient. What is the patient's heart rate? Is it normal? Or is it too slow or too fast? In this case, it's 80 beats per minute, but it's also irregular.
After looking at the heart rate, check to see if the patient's P-waves look normal by asking yourself the following few questions.
Next, look at the PR interval on the patient's ECG readout and ask yourself the following questions:
The last thing you should look at to determine if the sinus rhythm is normal or not is the QRS complex and ask yourself these questions while you do:
So, what is your cardiac interpretation? Based on these questions and on the findings from the ECG readout above, it would appear that this patient is in atrial fibrillation.
Pro Tip #2: Atrial fibrillation is rare in children. However, it can occur in pediatric patients with cardiomyopathy, and/or following complex heart surgery, and even more rarely in children with otherwise normal heart function.
For pediatric patients in atrial fibrillation, expert care and consultation is required to properly treat that child.
Survival rates from pediatric cardiac arrest vary according to the location of the arrest and the presenting rhythm.
According to the American Heart Association, the rate of survival to hospital discharge is higher if the arrest occurs in a hospital (43 percent) compared with out-of-hospital care (8 percent). Intact neurological survival is also greater if the cardiac arrest occurs while the patient is in a hospital.
It should be noted that the survival rate is higher (25 to 34 percent) when the patient's presenting rhythm is shockable (VF or pVT) compared to asystole (7 to 24 percent). The survival rate for a presenting rhythm of pulseless electrical activity is around 38 percent for in-hospital cardiac arrests.
However, when VF or pVT develop as a secondary rhythm during the resuscitation attempt for children in-hospital, survival rates are lower than those observed in cardiac arrests with non-shockable rhythms (11 percent vs. 27 percent, survival to discharge).
The highest survival rates (around 64 percent) occur when there is bradycardia and poor perfusion, and when chest compressions and ventilation are provided before pulseless arrest develops.