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Slow Atrial Fibrillation



  • Atrial fibrillation is most commonly associated with a rapid ventricular response, though AF with a slow ventricular response may occur when there is reduced conduction of fibrillatory waves through the conduction pathways.
    • Look For

    • Bradycardia with ventricular rate <60
    • Irregular rhythm
    • No P waves, with oscillating baseline waves
    • Causes of Atrial Fibrillation

    • Severe acute illness - especially in septic or postoperative patients
    • Cardiac - post cardiac surgery, myocardial infarction, valvular disease, cardiomyopathy, congestive cardiac failure, congenital heart disease, Wolff-Parkinson-White
    • Cardiovascular risk factors - hypertension, diabetes, obesity
    • Pulmonary embolism
    • Obstructive sleep apnoea
    • Thyrotoxicosis
    • Alcohol abuse
    • Causes of Slowed Ventricular Response

    • Complete heart block
    • Drugs - beta blockers, calcium channel blockers, digoxin
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Adan V, Crown LA. Diagnosis and treatment of sick sinus syndrome. American family physician. 2003 Apr;67(8):1725-32.
 Mangrum JM, DiMarco JP. The evaluation and management of bradycardia. New England Journal of Medicine. 2000 Mar 9;342(10):703-9.