COMMON CARDIAC ARRHYTHMIAS 2 the complex arrhythmias Mark Earley, St Bartholomew’s Hospital

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