HOSPITAL GENERAL PUYO

Medicina Interna.

Fibrilacin Auricular.

DEFINICIN:
Es una taquiarritmia supraventricular en la que la
aurcula se activa de manera descoordinada sin
contraccin efectiva.
Aparicin de estmulos desorganizados.
Puede disminuir el gasto cardaco, es el motivo ms
frecuente de ingreso hospitalario por insuficiencia
cardaca.

(1) January CT, Wann LS, Alpert JS, Calkins H, Cleveland JC Jr, Cigarroa JE, et al. 2014 AHA/ACC/HRS Guideline for the Management
of Patients With Atrial Fibrillation: Executive Summary: A Report of the American College of Cardiology/American Heart Association
Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation. 2014 Apr 10. [Epub ahead of print]. PubMed PMID:
24682348

DEFINICIN:
Estas frecuencias tan elevadas generan prdida de
la contraccin de las aurculas y stasis de la sangre
en ellas, favoreciendo la aparicin de trombos,
aumentando el riesgo de tromboembolismos.
La FA duplica la mortalidad y aumenta en 5 veces el
riesgo de sufrir un accidente cerebro-vascular.

(1) January CT, Wann LS, Alpert JS, Calkins H, Cleveland JC Jr, Cigarroa JE, et al. 2014 AHA/ACC/HRS Guideline for the Management
of Patients With Atrial Fibrillation: Executive Summary: A Report of the American College of Cardiology/American Heart Association
Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation. 2014 Apr 10. PubMed PMID: 24682348

PREVALENCIA:
0.6% entre los 40 y 49 aos.
1% de menores de 60 aos.
6.5% de mujeres mayores de 80 aos y a 8% de
varones de la misma edad.

(2) Gmez-Doblas JJ, Muiz J, Martin JJ, Rodrguez-Roca G, Lobos JM, Awamleh P, Permanyer-Miralda G, Chorro FJ, Anguita M, Roig
E; OFRECE study collaborators. Prevalence of atrial fibrillation in Spain. OFRECE study results. Rev Esp Cardiol(Engl Ed). 2014
Apr;67(4):259-69. doi: 10.1016/j.rec.2013.07.014. Epub 2013 Nov25. PubMed PMID: 24774588

CLASIFICACIN:
Es

(3) Wann LS, Curtis AB, January CT, Ellenbogen KA, Lowe JE, Estes NA 3rd, et al.; ACCF/AHA/HRS. 2011 ACCF/AHA/HRS focused
update on the management of patients with atrial fibrillation (Updating the 2006 Guideline): a report of the American College of
Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2011;57(2):223-42.
PubMed PMID: 21177058

CAUSAS:
La FA aparece cuando existen alteraciones estructurales o electrofisiolgicas
del tejido auricular, el impulso se produce y se transmite de manera anormal.
Las alteraciones estructurales pueden estar ocasionadas por fibrosis, dilatacin
o hipertrofia.

(1) January CT, Wann LS, Alpert JS, Calkins H, Cleveland JC Jr, Cigarroa JE, et al. 2014 AHA/ACC/HRS Guideline for the Management
of Patients With Atrial Fibrillation: Executive Summary: A Report of the American College of Cardiology/American Heart Association
Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation. 2014 Apr 10. PubMed PMID: 24682348

FISIOPATOLOGA:
Causas que pueden provocar hipertrofia celular, activacin de fibroblastos o fibrosis
de tejido que provoquen alteraciones en el funcionamiento de canales de calcio.
Cambios estructurales y electrofisiolgicos que permitan un remodelamiento atrial.
Remodelamiento atrial que pueda generar futuras arritmias.

(6) PHISIOL REV 2011 JAN; 91 (1) :265 DISPONIBLE EN : www.web.b.ebchohost.com.pbidi.unam.mx/8080/...

CAUSAS:
Enfermedades cardacas o valvulares:
Cardiopata isqumica.
Enfermedad cardiaca reumtica, estenosis mitral.
Sndrome de preexcitacin, Wolf Parkinson White (WPW).
Insuficiencia cardiaca.
Con menos frecuencia: cardiomiopata, enfermedad pericrdica, defecto del
tabique interauricular, mixoma auricular.

(1) January CT, Wann LS, Alpert JS, Calkins H, Cleveland JC Jr, Cigarroa JE, et al. 2014 AHA/ACC/HRS Guideline for the Management
of Patients With Atrial Fibrillation: Executive Summary: A Report of the American College of Cardiology/American Heart Association
Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation. 2014 Apr 10. PubMed PMID: 24682348

CAUSAS:
Causas no cardacas:
HTA.
Tirotoxicosis.
Infecciones agudas (neumona la mayora de los casos).
Cncer de pulmn.
Diabetes.
Sndrome de apnea del sueo.
(1) January CT, Wann LS, Alpert JS, Calkins H, Cleveland JC Jr, Cigarroa JE, et al. 2014 AHA/ACC/HRS Guideline for the Management
of Patients With Atrial Fibrillation: Executive Summary: A Report of the American College of Cardiology/American Heart Association
Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation. 2014 Apr 10. PubMed PMID: 24682348

CAUSAS:
En un 30-45% de casos de FA
paroxstica y en un 20-25% de
FA persistente no se identifica
ninguna enfermedad.

(1) January CT, Wann LS, Alpert JS, Calkins H, Cleveland JC Jr, Cigarroa JE, et al. 2014 AHA/ACC/HRS Guideline for the Management
of Patients With Atrial Fibrillation: Executive Summary: A Report of the American College of Cardiology/American Heart Association
Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation. 2014 Apr 10. PubMed PMID: 24682348

 Puede ser asintomtica.

DIAGNSTICO:

Disnea.
Dolor torcico.
Palpitaciones.
Mareo.
Sncope o poca resistencia a la actividad fsica.

(1) January CT, Wann LS, Alpert JS, Calkins H, Cleveland JC Jr, Cigarroa JE, et al. 2014 AHA/ACC/HRS Guideline for the Management
of Patients With Atrial Fibrillation: Executive Summary: A Report of the American College of Cardiology/American Heart Association
Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation. 2014 Apr 10. PubMed PMID: 24682348

DIAGNSTICO:

(2) Gmez-Doblas JJ, Muiz J, Martin JJ, Rodrguez-Roca G, Lobos JM, Awamleh P, Permanyer-Miralda G, Chorro FJ, Anguita M, Roig
E; OFRECE study collaborators. Prevalence of atrial fibrillation in Spain. OFRECE study results. Rev Esp Cardiol(Engl Ed). 2014
Apr;67(4):259-69. doi: 10.1016/j.rec.2013.07.014. Epub 2013 Nov25. PubMed PMID: 24774588

RIESGO DE TROMBOEMBOLIA:

Calcula el riesgo de
tromboembolia
y
articula
su
prevencin.

(1) January CT, Wann LS, Alpert JS, Calkins H, Cleveland JC Jr, Cigarroa JE, et al. 2014 AHA/ACC/HRS Guideline for the Management
of Patients With Atrial Fibrillation: Executive Summary: A Report of the American College of Cardiology/American Heart Association
Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation. 2014 Apr 10. PubMed PMID: 24682348

TRATAMIENTO:

Drugs for acute rate control of symptomatic atrial fibrillation with rapid ventricular
response
in patients without heart failure and without preexcitation, IV beta blocker or
nondihydropyridine calcium
channel blocker recommended (ACC/AHA Class I, Level B; ESC Class I, Level A)
esmolol 500 mcg/kg IV over 1 minute, then 50-300 mcg/kg/minute IV
metoprolol 2.5-5 mg IV bolus over 2 minutes, up to 3 doses (ACC/AHA Class I, Level C)
propranolol 1 mg IV over 1 minute, up to 3 doses at 2-minute intervals
diltiazem 0.25 mg/kg IV over 2 minutes, then 5-15 mg IV/hour (ACC/AHA Class I, Level B)
verapamil 0.075-0.15 mg/kg IV over 2 minutes (ACC/AHA Class I, Level B).
IV diltiazem may be more effective than IV amiodarone or digoxin for ventricular rate
control in patients.
(2) Gmez-Doblas JJ, Muiz J, Martin JJ, Rodrguez-Roca G, Lobos JM, Awamleh P, Permanyer-Miralda G, Chorro FJ, Anguita M, Roig
E; OFRECE study collaborators. Prevalence of atrial fibrillation in Spain. OFRECE study results. Rev Esp Cardiol(Engl Ed). 2014
Apr;67(4):259-69. doi: 10.1016/j.rec.2013.07.014. Epub 2013 Nov25. PubMed PMID: 24774588

BIBLIOGRAFIA
1.

MANUAL DE NORMAS Y PROCEDIMIENTOS SOBRE PREVENCIN Y TRATAMIENTO DE

ACCIDENTES OCASIONADOS POR MORDEDURA DE SERPIENTES. MSP