atrial fibrillation question..

allnurses Guide · Sep 23, 2009

Depends on the etiology. If it's due to an old, stretched atria, and they've been in AF a long time, it's rare to be able to revert them out of it. If it's due to an acute issue, yes it can flip in and out. It's an "irregularly irregular" rhythm - not much rhyme or reason to its patterns.

AJ BSN 2008 · Sep 23, 2009

Yes, I worked as a tele tech while attending nursing school and saw more than one pt spontaneously flip between SR and A-fib...among other rhythms, lol :smokin:

Acosmo27 · Sep 23, 2009

Thanks guys!

highlandlass1592, BSN, RN · Sep 23, 2009

Most definitely it can happen. What's interesting is trying to figure out the why...have they had surgery? Specific meds? AF is pretty common in the post-op cardiac surgery patient..especially with Mitral Valve patients.

al7139, ASN, RN · Sep 23, 2009

Hi,

I am a tele nurse, and I can tell you that I see lots of pts who flip flop between A-Fib and SR. This happens especially if they have chronic underlying conditions such as CHF. Also consider if when the pts 12 lead was done, did they give them any antiarrhythmics in the ED like Amio or Cardizem. In that case, even if the A-Fib was new, the drugs given may have caused the patient to convert to a normal rhythm by the time they were in the unit (did they not transport the pt on a portable monitor?).

We get patients that are new diagnosis A-Fib, and depending on whether they are controlled ( heart rate less than 100) or uncontrolled (heart rate greater than 100) will either be on PO meds or a drip. If the pt is in uncontrolled A fib, they may get cardioverted (a shock to the heart delivered by a defibrillator) if they are symptomatic, or be placed on an antiarrhythmic drip like cardizem. If they convert on the drip, they are switched to PO and monitored for 2-3 days to see if the po works.

It is important to remember that A-Fib is usually a symptom of a disease, not a diagnosis, so you need to learn why this patient has this rhythm to treat the cause, not just the rhythm.

Hope this helps.

Amy

hypocaffeinemia, BSN, RN · Sep 23, 2009

Hello--
This may be a silly question to anyone with experience, but Im a little perplexed. Im a student (last semester!) and Im currently doing a rotation in the ED. I had a patient that in triage showed atrial fibrillation on the 12 lead, however by the time we got her to the unit and put her on the monitor, was in sinus brady... I know she has a history of atrial fibrillation however my question is... do some people randomly go into atrial fibrillation and are able to covert back to normal sinus rhythm spontaneously on their own with no treatment?
I meant to ask my preceptor however being that the ED is so crazy sometimes, I forgot.. I will bring it up the next time I see her, but in the meantime would like to get your input. thank you!!!

Many people spontaneously convert back and forth. I've seen people go in and out of atrial fib several times in the same minute.

Virgo_RN, BSN, RN · Sep 23, 2009

do some people randomly go into atrial fibrillation and are able to covert back to normal sinus rhythm spontaneously on their own with no treatment?

Yep, they can and sometimes do.

Editorial Team / Moderator · Sep 23, 2009

They usually convert when you approach them with the EKG machine. LOL! I had a guy flipping between sinus and atrial flutter. Every time I'd hook up the EKG machine, he'd go back to SR. Arrghh! So I left the darn thing hooked to him for 20 minutes, and nada -- SR the whole time. And then wouldn't you know it ... as I'm rolling the EKG machine away, he went back into atrial flutter. ARRGHHH!! Ha ha. I did have him on the central monitor so I got some strips of it, but wanted to catch it on the 12-lead. Never did! Dodgy rhythm. :)

emtb2rn, BSN, RN, EMT-B · Sep 23, 2009

This may be a silly question to anyone with experience, but Im a little perplexed.

No such thing as a silly question. Keep on asking.

Had a lol brought in by squad from the snf for wheezing. Sitting there happy as a clam, calm cool & collected, albeit only oriented to self. In the hallway getting vitals and the rover shows a hr of 173. Hmmm, check radial pulse, yeah 170s feels about right. stat ekg and she's a-fib, asymptomatic so she gets cardizem. Only complaint was too much noise.