From the Guidelines
Atrial rhythm on an EKG is characterized by the presence or absence of distinct P waves and the regularity of RR intervals, with atrial fibrillation defined as a cardiac arrhythmia with absolutely irregular RR intervals and no distinct P waves on the surface ECG. According to the guidelines for the management of atrial fibrillation by the European Society of Cardiology (ESC) 1, atrial fibrillation is defined by three key characteristics:
- The surface ECG shows absolutely irregular RR intervals,
- There are no distinct P waves on the surface ECG, and
- The atrial cycle length is usually variable and < 200 ms (≥300 bpm). When interpreting atrial rhythm, it is essential to assess the P wave morphology, the PR interval, and the relationship between P waves and QRS complexes, as this information is crucial for diagnosing various cardiac conditions and determining appropriate treatment strategies. Abnormal atrial rhythms, such as atrial fibrillation, can have significant implications for morbidity, mortality, and quality of life, and accurate diagnosis is critical for guiding treatment decisions 1.
From the Research
Atrial Rhythm on EKG
- Atrial fibrillation (AF) is the most common arrhythmia worldwide and is expected to increase in prevalence 2
- Atrial arrhythmias, including AF, atrial flutter (AFL), atrioventricular nodal reentry tachycardia (AVNRT), and atrioventricular reentrant tachycardia (AVRT), require nuanced management according to patient subset and risk factors 2
- Electrical cardioversion for atrial arrhythmias is generally successful and often indicated, depending on the setting and/or hemodynamics 2
Diagnosis and Treatment
- Atrial arrhythmias are typically associated with greater hemodynamic stability than ventricular arrhythmias, but still require appropriate management 2
- Antiarrhythmics can be proarrhythmic and may destabilize the patient due to adverse effects, many of which are the focus of black-box label warnings 2
- Apixaban and rivaroxaban are commonly used oral anticoagulants for ischemic stroke prevention in patients with atrial fibrillation, with apixaban associated with a lower risk of major ischemic or hemorrhagic events compared to rivaroxaban 3
Cost-Effectiveness
- Treating atrial fibrillation patients with rivaroxaban and apixaban instead of warfarin reduces healthcare costs, with per-patient 1-year healthcare cost savings of $2436 and $1764, respectively 4
- Apixaban is associated with a lower risk of ischemic stroke or systemic embolism and bleeding compared to rivaroxaban in patients with atrial fibrillation and valvular heart disease 5