A TRIAL fibrillation (AF) is the most common cardiac arrhythmia encountered in adults. The estimated overall AF prevalence in ambulatory populations is 1%, though this percentage is much higher in adults older than 65 yr of age. 1 AF risk factors include the male sex, increasing age, and Caucasian ethnicity (table 1). 1-4 The AF incidence is growing, as the prevalence has increased by over 20% in recent studies. 5 AF-associated morbidity is costly and is secondary to the increased risk of heart failure and stroke. 6 We now review the anesthetic considerations of endovascular ablation for the treatment of AF. Pathophysiology Atrial fibrillation is characterized by disorganized electrical and mechanical heart activity that arises in the atria with an accompanying irregular ventricular response. An electrocardiogram is essential to confirm AF, which reveals irregular R-R intervals (in the absence of a complete atrioventricular node blockage), an absence of P waves, and a variable atrial cycle length that is usually less than 200 ms. 7 Electrocardiogram monitoring demonstrates that many episodes of AF are self-terminating and asymptomatic. However, with time, the duration of episodes becomes longer, leading to sustained AF. 8 Atrial fibrillation development requires both a susceptible substrate and a triggering episode. 7 In the normal electrical conduction pathway, the sinoatrial node is the heart pacemaker. In AF, the trigger to myocardial depolarization predominantly develops in the atria and neighboring pulmonary veins (PVs). The PVs are the most common source of the rapid ectopic beats that trigger AF. 9 Recent evidence suggests that once AF is triggered, the arrhythmia is sustained
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