A 60-year-old man with a known history of chronic obstructive pulmonary disease is brough to the emergency department due to chest palpitation and lightheadeness. He has a histroy of multiple episodes of intermittent chest palpitations. His only medication is a tiotropium-formoterol inhaler. His pulse is 140/min and irregular. respiration is 17/min and blood pressure 118/72. Pulse oximetry on room air shows an oxygen saturation of 96%. Chest examination reveals no murmurs and the lungs are clear on auscultation. There is trace peripheral edema. Cardiac rhythm strip obtained in the emergency department is shown in the exhibit.
Aberrant electrical activity in which of the following anatomic structures is the most likely trigger for this patient's current condition?

Question

Quizplus · Accepted Answer

Eductional Objective: any patient with palpitation and irregular irregular rhythm with variable R-R intervals and absence of P waves on ECG are suggested to be Atrial fibrillation. The development of AF most commonly involves ectopic electrical foci in the pulmonary veins that trigger fibrillatory conduction in abnormal (remodeled) atrial tissue.

A 60-Year-Old Man with a Known History of Chronic Obstructive