Atrial fibrillation (AF) is an irregular and often abnormally fast heartbeat that can lead to blood clots, stroke, heart failure and other heart-related complications. Normally, the heart contracts and relaxes to a regular beat (between 60 and 100 beats a minute) when the person is resting. In AF, the upper chambers of the heartbeat irregularly and sometimes at a very fast pace, and can be much higher than 100 beats a minute.
AF is widespread among older patients admitted to ICU with chronic conditions who are at risk for critical illness. New-onset AFIB has been found to be a common complication after cardiac surgery and also occurs among critically ill patients with a high incidence of renal failure and sepsis.
AFIB can exist without any symptoms and remain undetected until the person has a medical check-up. The common signs and symptoms of atrial fibrillation are palpitations, dizziness, shortness of breath, fatigue, weakness, reduced ability to exercise, lightheadedness, chest pain. AFIB can cause blood clots, stroke, hypotension, and heart failure with subsequent organ dysfunction.
The exact causes of atrial fibrillation are unknown, but it is generally considered the result of high blood pressure and coronary artery disease. Conditions that increase risk of developing AF include age, hypertension, underlying heart disease and conditions, family history, sleep apnea, thyroid disease, diabetes, asthma, chronic kidney disease, previous kidney disease, previous heart surgery, viral infections, obesity,m stress due to surgery, exposure to stimulants, sick sinus syndrome, and alcohol. Since there are different types of arrhythmias, testing using an electrocardiogram (ECG/EKG), Holter monitor, event recorder, or echocardiogram may be ordered to enable correct diagnosis. Identifying AFIB type will facilitate proper treatment planning.
The atrial fibrillation treatment that is most appropriate for you will depend on how long you’ve had atrial fibrillation, how bothersome your symptoms are and the underlying cause of your atrial fibrillation. Generally, the treatment goals for atrial fibrillation are to reset the rhythm or control the rate and prevent blood clots. Ideally, to treat atrial fibrillation, the heart rate and rhythm are reset to normal. To correct your condition, doctors may be able to reset your heart to its regular rhythm (sinus rhythm) using a procedure called cardioversion, depending on the underlying cause of atrial fibrillation and how long you’ve had it. Cardioversion can be done in two ways: electrical cardioversion and cardioversion with drugs. Before cardioversion, you may be given warfarin or another blood-thinning medication for several weeks to reduce the risk of blood clots and strokes. If your episode of atrial fibrillation lasted more than 48 hours, you may need to take this type of medication for at least a month after the procedure to prevent blood clots in the heart. After electrical cardioversion, your doctor may prescribe anti-arrhythmic medications to help prevent future episodes of atrial fibrillation. Medications may include dofetilide, flecainide, propafenone, amiodarone, and sotalol. Although these drugs may help maintain a normal heart rhythm, they can cause side effects, including nausea, dizziness, and fatigue. Rarely, they may cause ventricular arrhythmias — life-threatening rhythm disturbances originating in the heart’s lower chambers. These medications may be needed indefinitely. Even with medications, there is a chance of another episode of atrial fibrillation. You may be prescribed medications to control how fast your heart beats and restore it to a normal rate, like digoxin, beta blockers, and calcium channel blockers. Many people with atrial fibrillation or those who are undergoing certain treatments for atrial fibrillation are at especially high risk of blood clots that can lead to a stroke. The risk is even higher if other heart disease is present along with atrial fibrillation. Your doctor may prescribe blood-thinning medications (anticoagulants) such as warfarin and newer anticoagulants. Many people have spells of atrial fibrillation and don’t even know it — so you may need lifelong anticoagulation even after your rhythm has been restored to normal.
It is very important to explicitly document findings that support the diagnosis of atrial fibrillation. A chronic disease, like atrial fibrillation, must have a valid treatment plan in order to be considered an active medical problem. Treatment plans can be in the form of: a medication, referral, diet, monitoring, and/or ordering a diagnostic exam. Common treatment modalities include medications such as: beta-blockers, calcium channel blockers, anti-arrhythmic, and anticoagulants to reduce; stroke burden; procedures such as: direct current cardioversion with or without trans-esophageal guidance and catheter-based ablation; document diagnostic statements that are compatible with the ICD-10 nomenclature; and confirm face-to-face encounter is signed and dated by the clinician. Include the printed version of the clinician’s full name and credentials.
The table below includes the Most commonly used ICD-10 codes for Atrial Fibrillation:
|ICD-10 Chapter||Codes||Code Description|
|9||I48.0||Paroxysmal atrial fibrillation|
|9||I48.11||Longstanding persistent atrial fibrillation|
|9||I48.19||Other persistent atrial fibrillation|
|9||I48.20||Chronic atrial fibrillation, unspecified|
|9||I48.21||Permanent atrial fibrillation|
|9||I48.91||Unspecified atrial fibrillation|
|21||Z86.79||History of AFIB|
Author: Tonoya Ahmed