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Showing posts with label Atrial fibrillation. Show all posts
Showing posts with label Atrial fibrillation. Show all posts

What is the role of surgery in the treatment of atrial fibrillation ?

What is the role of surgery in the treatment of atrial fibrillation ?

• A novel surgical technique, the Maze procedure, has recently been described in which multiple
incisions are made in the atria to prevent re-entrant loops (Clin Curdiol 1991; 14:827 34). This
procedure is highly effective in preventing atrial fibrillation: only one patient out of 65 suffered a
clinical recurrence of the arrhythmia three or more months after the procedure. Although the
long-term outcome is not known, it remains a promising procedure when atrial fibrillation is not
controlled by medical therapy or in those cases complicated by recurrent thromboembolism.

• The 'corridor' procedure effectively isolates both the left and right atrium, leaving a strip of
myocardium connecting the sinus node to the atrioventricular node. This procedure does not prevent
atrial fibrillation but isolates the fibrillating atria. Although a 70% 'cure' rate is reported, sequential
atrioventricular contraction is not restored (with the consequent haemodynamic effects and the risk of
thromboembolism).
What is the role of surgery in the treatment of atrial fibrillation ?

• A novel surgical technique, the Maze procedure, has recently been described in which multiple
incisions are made in the atria to prevent re-entrant loops (Clin Curdiol 1991; 14:827 34). This
procedure is highly effective in preventing atrial fibrillation: only one patient out of 65 suffered a
clinical recurrence of the arrhythmia three or more months after the procedure. Although the
long-term outcome is not known, it remains a promising procedure when atrial fibrillation is not
controlled by medical therapy or in those cases complicated by recurrent thromboembolism.

• The 'corridor' procedure effectively isolates both the left and right atrium, leaving a strip of
myocardium connecting the sinus node to the atrioventricular node. This procedure does not prevent
atrial fibrillation but isolates the fibrillating atria. Although a 70% 'cure' rate is reported, sequential
atrioventricular contraction is not restored (with the consequent haemodynamic effects and the risk of
thromboembolism).

What is the role of oral anticoagulants in chronic atrial fibrillation ?

What is the role of oral anticoagulants in chronic atrial fibrillation ?

Non-rheumatic atrial fibrillation is an important risk factor for stroke, even though it is recognized that only 80% of strokes in such patients the heart. All patients with non-rheumatic atrial fibrillation should be anticoagulated with warfarin unless there are contraindications (Br J Hosp Med 1993: 50: 452-7).
What is the role of oral anticoagulants in chronic atrial fibrillation ?

Non-rheumatic atrial fibrillation is an important risk factor for stroke, even though it is recognized that only 80% of strokes in such patients the heart. All patients with non-rheumatic atrial fibrillation should be anticoagulated with warfarin unless there are contraindications (Br J Hosp Med 1993: 50: 452-7).

How would you treat a patient with atrial fibrillation ?

How would you treat a patient with atrial fibrillation ?

Attempt to restore slow ventricular rate:

• In the hypertensive patient use calcium antagonists (verapamil, diltiazem).

• In thyroid disease use a beta-blocker (e.g. propranolol).

• In ischaemic heart disease use a beta-blocker or diltiazem, verapamil.

• In heart failure use digoxin or verapamil.

• In hypertrophic cardiomyopathy use a beta-blocker or calcium antagonists.

• In those who are intolerant of or do not respond to drugs, radiofrequency catheter ablation of the
atrioventricular node (with a cardiac pacemaker) may provide symptomatic relief; however, it does not
change the risk of systemic emboli or the need for anticoagulation (N Engl J Med 1999; 340: 534).

• More recently, radiofrequency ablation of the pulmonary veins has been shown to be effective in
paroxysmal atrial fibrillation when the ectopic focus is in the pulmonary veins.

Attempt to restore sinus rhythm by cardioversion if the following conditions apply:

• Left atrial size by echocardiogram is less than 4.5 cm (left atrial size >4.5 cm is not associated with
long-term maintenance of sinus rhythm).

• Short duration of the arrhythmia (acute atrial fibrillation is likely to remain in sinus rhythm).

• Drugs used to restore sinus rhythm or prevent recurrence include quinidine, procainamide,
disopyramide, propafenone, sotalol, fiecainide, amiodarone and ibutilide (N Engl J Med 2000;
342:913-20; Circulation 1996; 94:1613).


Anticoagulation with warfarin is advised for certain patients':

• Undergoing cardioversion (electrical or drug).
• With underlying mitral valve disease.
• In left ventricular failure.
• With cardiomyopathy.
• Above the age of 60 years.
How would you treat a patient with atrial fibrillation ?

Attempt to restore slow ventricular rate:

• In the hypertensive patient use calcium antagonists (verapamil, diltiazem).

• In thyroid disease use a beta-blocker (e.g. propranolol).

• In ischaemic heart disease use a beta-blocker or diltiazem, verapamil.

• In heart failure use digoxin or verapamil.

• In hypertrophic cardiomyopathy use a beta-blocker or calcium antagonists.

• In those who are intolerant of or do not respond to drugs, radiofrequency catheter ablation of the
atrioventricular node (with a cardiac pacemaker) may provide symptomatic relief; however, it does not
change the risk of systemic emboli or the need for anticoagulation (N Engl J Med 1999; 340: 534).

• More recently, radiofrequency ablation of the pulmonary veins has been shown to be effective in
paroxysmal atrial fibrillation when the ectopic focus is in the pulmonary veins.

Attempt to restore sinus rhythm by cardioversion if the following conditions apply:

• Left atrial size by echocardiogram is less than 4.5 cm (left atrial size >4.5 cm is not associated with
long-term maintenance of sinus rhythm).

• Short duration of the arrhythmia (acute atrial fibrillation is likely to remain in sinus rhythm).

• Drugs used to restore sinus rhythm or prevent recurrence include quinidine, procainamide,
disopyramide, propafenone, sotalol, fiecainide, amiodarone and ibutilide (N Engl J Med 2000;
342:913-20; Circulation 1996; 94:1613).


Anticoagulation with warfarin is advised for certain patients':

• Undergoing cardioversion (electrical or drug).
• With underlying mitral valve disease.
• In left ventricular failure.
• With cardiomyopathy.
• Above the age of 60 years.

What do you understand by the term 'atrial fibrillation' ?


What do you understand by the term 'atrial fibrillation' ?
 

Lone atrial fibrillation occurs itl the absence of cardiopulmonary disease or a history of hypertension and before the age of 60 years. Such patients have a low risk of stroke (0.5% per year).

What do you understand by the term 'atrial fibrillation' ?
 

Lone atrial fibrillation occurs itl the absence of cardiopulmonary disease or a history of hypertension and before the age of 60 years. Such patients have a low risk of stroke (0.5% per year).

In which congenital disorders is atrial fibrillation common ?

In which congenital disorders is atrial fibrillation common ?

Atrial septal defect, Ebstein's anomaly.
In which congenital disorders is atrial fibrillation common ?

Atrial septal defect, Ebstein's anomaly.

At the bedside, how would you differentiate atrial fibrillation from multiple ventricular ectopics ?

At the bedside, how would you differentiate atrial fibrillation from multiple ventricular ectopics ?

If the patient is not in heart failure, exercise the patient; after exercise, ventricular ectopics tend to
diminish in frequency whereas there is no change in the rhythm of atrial fibrillation.
At the bedside, how would you differentiate atrial fibrillation from multiple ventricular ectopics ?

If the patient is not in heart failure, exercise the patient; after exercise, ventricular ectopics tend to
diminish in frequency whereas there is no change in the rhythm of atrial fibrillation.

What are the common causes of atrial fibrillation ?

What are the common causes of atrial fibrillation ?

• Mitral valvular disease in the young and middle-aged.
• Ischaemic heart disease or hypertension in the elderly.
• Thyrotoxicosis (atrial fibrillation may be the only clinical feature in the elderly).
• Constrictive pericarditis.
• Chronic pulmonary disease.
What are the common causes of atrial fibrillation ?

• Mitral valvular disease in the young and middle-aged.
• Ischaemic heart disease or hypertension in the elderly.
• Thyrotoxicosis (atrial fibrillation may be the only clinical feature in the elderly).
• Constrictive pericarditis.
• Chronic pulmonary disease.

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