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Ray L, Geier C, DeWitt KM. Pathophysiology and treatment of adults with arrhythmias in the emergency department, part 2: Ventricular and bradyarrhythmias. Am J Health Syst Pharm 2023; 80:1123-1136. [PMID: 37235971 DOI: 10.1093/ajhp/zxad115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE This is the second article in a 2-part series reviewing the pathophysiology and treatment considerations for arrhythmias. Part 1 of the series discussed aspects related to treating atrial arrhythmias. Here in part 2, the pathophysiology of ventricular arrhythmias and bradyarrhythmias and current evidence on treatment approaches are reviewed. SUMMARY Ventricular arrhythmias can arise suddenly and are a common cause of sudden cardiac death. Several antiarrhythmics may be effective in management of ventricular arrhythmias, but there is robust evidence to support the use of only a few of these agents, and such evidence was largely derived from trials involving patients with out-of-hospital cardiac arrest. Bradyarrhythmias range from asymptomatic mild prolongation of nodal conduction to severe conduction delays and impending cardiac arrest. Vasopressors, chronotropes, and pacing strategies require careful attention and titration to minimize adverse effects and patient harm. CONCLUSION Ventricular arrhythmias and bradyarrhythmias can be consequential and require acute intervention. As experts in pharmacotherapy, acute care pharmacists can participate in providing high-level intervention by aiding in diagnostic workup and medication selection.
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Affiliation(s)
- Lance Ray
- Denver Health and Hospital Authority, Denver, CO, and Department of Emergency Medicine, University of Colorado, Aurora, CO, USA
| | - Curtis Geier
- San Francisco General Hospital, San Francisco, CA, USA
| | - Kyle M DeWitt
- University of Vermont Medical Center, Burlington, VT, USA
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2
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Wide Complex Tachycardias. Emerg Med Clin North Am 2022; 40:733-753. [DOI: 10.1016/j.emc.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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3
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The Epidemiology and Effectiveness of Synchronized Cardioversion in a UK Prehospital Setting: A Retrospective Cross-Sectional Study. Prehosp Disaster Med 2021; 36:440-444. [PMID: 34127157 DOI: 10.1017/s1049023x21000546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Synchronized cardioversion is an internationally accepted standard therapy for unstable tachyarrhythmias, but it is conventionally an in-hospital physician-led intervention. Increasingly, it is being brought forward into the prehospital setting as part of a specialist paramedic scope of practice; however, very little literature exists regarding the epidemiology or efficacy in this setting. METHODS All patients receiving cardioversion within a United Kingdom (UK) ambulance service were identified using an electronic database. The period of inclusion was March 1, 2017 through October 31, 2020. These data were then interrogated to provide demographic, physiological, and efficacy data, and then a sub-group was created to identify those who presented with a primary arrhythmia (as opposed to post-cardiac arrest). RESULTS From a total of 93 patients, prehospital synchronized cardioversion successfully terminated the tachyarrhythmia in 96% of patients presenting with a primary arrhythmia (85% in the allcomers group) with a predominance towards males (82% of patients) and an average age of 67 years. Hypotension and reduced level of consciousness were the most commonly documented unstable features (84.4% and 44.4%). CONCLUSION Cardioversion within a paramedic-led service results in efficacy rates of 96% in patients presenting with a primary tachyarrhythmia. This is a similar efficacy rate to traditional doctor-led therapies. Demographic data show that males make up over 80% of the patient population, in keeping with previously published work across the spectrum of cardiac interventions.
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Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, Kudenchuk PJ, Kurz MC, Lavonas EJ, Morley PT, O’Neil BJ, Peberdy MA, Rittenberger JC, Rodriguez AJ, Sawyer KN, Berg KM, Arafeh J, Benoit JL, Chase M, Fernandez A, de Paiva EF, Fischberg BL, Flores GE, Fromm P, Gazmuri R, Gibson BC, Hoadley T, Hsu CH, Issa M, Kessler A, Link MS, Magid DJ, Marrill K, Nicholson T, Ornato JP, Pacheco G, Parr M, Pawar R, Jaxton J, Perman SM, Pribble J, Robinett D, Rolston D, Sasson C, Satyapriya SV, Sharkey T, Soar J, Torman D, Von Schweinitz B, Uzendu A, Zelop CM, Magid DJ. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S366-S468. [DOI: 10.1161/cir.0000000000000916] [Citation(s) in RCA: 371] [Impact Index Per Article: 92.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Gardner MW, Yadava M, Raitt MH, Elman MR, Zarraga IG, MacMurdy KS, Dalouk KA, Jessel PM. Effectiveness of dual external direct current cardioversion for initial cardioversion in atrial fibrillation. J Cardiovasc Electrophysiol 2019; 30:1636-1643. [PMID: 31111594 DOI: 10.1111/jce.13994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/18/2019] [Accepted: 05/14/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Dual external direct current cardioversion (dual-DCCV) is a rhythm control strategy for persistent atrial fibrillation (AF), involving simultaneous delivery of two shocks from two defibrillators. The long-term effectiveness of this approach has not been studied in the biphasic cardioversion era. METHODS Seventy-seven consecutive patients at a single center were identified to receive dual-DCCV at the time of their initial cardioversion for AF, when maximum output standard external direct current cardioversion failed in two vectors. Logistic regression was used to analyze risk factors for dual-DCCV in a historical control group of 77 patients undergoing standard cardioversion and Cox proportional hazard models were used to compare time to AF recurrence. RESULTS The dual-DCCV group had a significantly larger body mass index (BMI), but similar AF duration and left atrial size as controls. Multivariable logistic regression revealed that BMI and absence of prior paroxysmal AF were risk factors for dual-DCCV (P < 0.05). There was no difference observed between dual-DCCV and control groups (adjusted hazard ratio = 0.57; P = .12) after adjusting for number of shocks and age. Transient hypoxia was the only acute complication in either group (P > .999). CONCLUSION Dual-DCCV appears to be a safe and effective cardioversion strategy for patients with AF. The need for dual-DCCV in the treatment of AF appears to be influenced more by body habitus than atrial substrate.
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Affiliation(s)
- Michael W Gardner
- Knight Cardiovascular Institute, Division of Cardiology, Oregon Health & Science University Hospital, Portland, Oregon
| | - Mrinal Yadava
- Knight Cardiovascular Institute, Division of Cardiology, Oregon Health & Science University Hospital, Portland, Oregon
| | - Merritt H Raitt
- Knight Cardiovascular Institute, Division of Cardiology, Oregon Health & Science University Hospital, Portland, Oregon.,Division of Cardiology, VA Portland Health Care System, Portland, Oregon
| | - Miriam R Elman
- School of Public Health, Division of Biostatistics, Oregon Health & Science University-Portland State University, Portland, Oregon
| | - Ignatius G Zarraga
- Knight Cardiovascular Institute, Division of Cardiology, Oregon Health & Science University Hospital, Portland, Oregon.,Division of Cardiology, VA Portland Health Care System, Portland, Oregon
| | - Karen S MacMurdy
- Knight Cardiovascular Institute, Division of Cardiology, Oregon Health & Science University Hospital, Portland, Oregon.,Division of Cardiology, VA Portland Health Care System, Portland, Oregon
| | - Khidir A Dalouk
- Knight Cardiovascular Institute, Division of Cardiology, Oregon Health & Science University Hospital, Portland, Oregon.,Division of Cardiology, VA Portland Health Care System, Portland, Oregon
| | - Peter M Jessel
- Knight Cardiovascular Institute, Division of Cardiology, Oregon Health & Science University Hospital, Portland, Oregon.,Division of Cardiology, VA Portland Health Care System, Portland, Oregon
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Littmann L, Olson EG, Gibbs MA. Initial evaluation and management of wide-complex tachycardia: A simplified and practical approach. Am J Emerg Med 2019; 37:1340-1345. [PMID: 31027937 DOI: 10.1016/j.ajem.2019.04.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/10/2019] [Accepted: 04/12/2019] [Indexed: 11/26/2022] Open
Abstract
The evaluation and treatment of wide QRS-complex tachycardia remains a challenge, and mismanagement is quite common. Diagnostic aids such as wide-complex tachycardia algorithms perform poorly in the real-life setting. The purpose of this review is to offer a simple clinical-electrocardiographic approach for the initial evaluation and management of the adult patient with stable wide-complex tachycardia that does not require recollection of complex guidelines or algorithms.
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Affiliation(s)
- Laszlo Littmann
- Department of Internal Medicine, Carolinas Medical Center, Charlotte, NC, United States.
| | - Elizabeth G Olson
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC, United States
| | - Michael A Gibbs
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC, United States
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Montenero AS, Andrew P. Current treatment options for atrial flutter and results with cryocatheter ablation. Expert Rev Cardiovasc Ther 2014; 4:191-202. [PMID: 16509815 DOI: 10.1586/14779072.4.2.191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Rhythm disturbances arising in the upper chambers of the heart are not uncommon. They are associated with a heavy burden of illness for the affected individual, as well as society in general. Atrial flutter, a re-entrant atrial tachycardia, is one such rhythm disturbance. The objective of this review article is twofold: first, to provide a brief insight into atrial flutter and the typical treatments for this arrhythmia in clinical practice; and second, to give an in-depth account of cryocatheter ablation as a relatively new treatment option for this potentially debilitating condition. The many recent clinical studies documenting the use of cryocatheter ablation for treatment of atrial flutter are presented, and their results briefly discussed. Overall, as cryocatheter ablation embeds itself among the arsenal of treatments for atrial flutter, the promising results from clinical studies appear destined to elevate cryocatheter ablation to a premier position among the treatment options for atrial flutter.
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Affiliation(s)
- Annibale S Montenero
- MultiMedica General Hospital, Via Milanese 300, 20099, Sesto S. Giovanni, Milan, Italy.
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Abstract
Radio frequency (RF) is electromagnetic radiation in the frequency range of 3-300GHz. The primary effects of RF energy on living tissue are considered to be thermal. The goal of the new devices based on these frequency ranges is to heat specific layers of the skin. The directed use of RF can induce dermal heating and cause collagen degeneration. Wound healing mechanisms promote the remodeling of collagen and wound contraction, which ultimately clinically enhances the appearance of mild to moderate skin laxity. Preliminary studies have reported efficacy in the treatment of laxity that involves the periorbital area and jowls. Because RF energy is not dependent on specific chromophore interaction, epidermal melanin is not at risk of destruction and treatment of all skin types is possible. As such, radiofrequency-based systems have been used successfully for nonablative skin rejuvenation, atrophic scar revision and treatment of unwanted hair, vascular lesions and inflammatory acne. The use of RF is becoming more popular, although a misunderstanding exists regarding the mechanisms and limitations of its actions. This concise review serves as an introduction and guide to many aspects of RF in the non ablative rejuvenation of skin.
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Affiliation(s)
- Mohamed Lotfy Elsaie
- MBAFellow of Dermatology and Cutaneous Surgery, University Miami School of Medicine, USA
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Park S, Kim DG, Suh GY, Park WJ, Jang SH, Hwang YI, Han SJ, Jeong HH, Lee CH, Jung KS. Significance of new-onset prolonged sinus tachycardia in a medical intensive care unit: a prospective observational study. J Crit Care 2011; 26:534.e1-534.e8. [PMID: 21376521 DOI: 10.1016/j.jcrc.2011.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 12/23/2010] [Accepted: 01/01/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Few data are available on sinus tachycardia among medical intensive care unit (ICU) patients. We investigated new critical illnesses related to new-onset prolonged sinus tachycardia (NOPST) and the relationship of NOPST with ICU mortality. METHODS The heart rate (HR) of all enrolled patients was monitored hourly over a 12-month period, and NOPST was defined as sinus tachycardia (>100 beats/min) with an increase in HR of more than 20% from the baseline value lasting longer than 6 hours. RESULTS Among the 522 patients enrolled, the average mean HR was 96.1 ± 18.4 beats/min. Fifty-two (10.0%) patients met the criteria for NOPST; pneumonia, delirium, septic shock, acute respiratory distress syndrome, catheter-related infections, and mechanical ventilator-related problems were related to the occurrence of NOPST. The ICU mortality rate in patients with a NOPST duration of more than 72 hours was higher compared with other patients with NOPST (60.0% vs 18.5%; P = .002). A high daily mean HR rather than NOPST was a significant predictor of ICU mortality (odds ratio, 1.415; 95% confidence interval, 1.177-1.700). CONCLUSIONS Although NOPST was not associated with ICU mortality, it indicates the presence of new critical events in the medical ICU setting.
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Affiliation(s)
- Sunghoon Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 896 Anyang, Gyeonggi-do, Republic of Korea
| | - Dong-Gyu Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 896 Anyang, Gyeonggi-do, Republic of Korea
| | - Gee Young Suh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Seoul, Republic of Korea
| | - Woo Jung Park
- Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 896 Anyang, Gyeonggi-do, Republic of Korea
| | - Seung Hun Jang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 896 Anyang, Gyeonggi-do, Republic of Korea
| | - Yong Il Hwang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 896 Anyang, Gyeonggi-do, Republic of Korea
| | - Sang-Jin Han
- Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 896 Anyang, Gyeonggi-do, Republic of Korea
| | - Hyun Hee Jeong
- Department of Nursing, Hallym University Sacred Heart Hospital, 896 Anyang, Gyeonggi-do, Republic of Korea
| | - Chang-Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 39 Boramae-gil, Seoul, Republic of Korea
| | - Ki-Suck Jung
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 896 Anyang, Gyeonggi-do, Republic of Korea.
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Ghosh N, Luk A, Derzko C, Dorian P, Chow CM. The Acute Treatment of Maternal Supraventricular Tachycardias During Pregnancy: A Review of the Literature. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2011; 33:17-23. [DOI: 10.1016/s1701-2163(16)34767-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Abstract
External electrical cardioversion was first performed in the 1950s. Urgent or elective cardioversions have specific advantages, such as termination of atrial and ventricular tachycardia and recovery of sinus rhythm. Electrical cardioversion is life-saving when applied in urgent circumstances. The succcess rate is increased by accurate tachycardia diagnosis, careful patient selection, adequate electrode (paddles) application, determination of the optimal energy and anesthesia levels, prevention of embolic events and arrythmia recurrence and airway conservation while minimizing possible complications. Potential complications include ventricular fibrillation due to general anesthesia or lack of synchronization between the direct current (DC) shock and the QRS complex, thromboembolus due to insufficient anticoagulant therapy, non-sustained VT, atrial arrhythmia, heart block, bradycardia, transient left bundle branch block, myocardial necrosis, myocardial dysfunction, transient hypotension, pulmonary edema and skin burn. Electrical cardioversion performed in patients with a pacemaker or an incompatible cardioverter defibrillator may lead to dysfunction, namely acute or chronic changes in the pacing or sensitivity threshold. Although this procedure appears fairly simple, serious consequences might occur if inappropriately perfformed.
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Affiliation(s)
- Murat Sucu
- Department of Cardiology, Gaziantep University School of Medicine, Gaziantep, Turkey
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Annane D, Sébille V, Duboc D, Le Heuzey JY, Sadoul N, Bouvier E, Bellissant E. Incidence and Prognosis of Sustained Arrhythmias in Critically Ill Patients. Am J Respir Crit Care Med 2008; 178:20-5. [DOI: 10.1164/rccm.200701-031oc] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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15
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Gessman LJ, Trohman R. Cardiac Arrhythmias. Crit Care Med 2008. [DOI: 10.1016/b978-032304841-5.50034-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
In recent years, several new radiofrequency devices have been introduced for treatment of a variety of skin conditions, particularly, skin wrinkling and laxity. These nonsurgical systems induce tissue tightening and contour changes through dermal collagen remodeling without disruption of the overlying epidermis, obviating a significant recovery period or risk of serious adverse sequelae. As such, radiofrequency-based systems have been used successfully for nonablative skin rejuvenation, atrophic scar revision, and treatment of unwanted hair, vascular lesions, and inflammatory acne.
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Affiliation(s)
- Tina S Alster
- Washington Institute of Dermatologic Laser Surgery, Washington, DC 20005, USA.
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Andrew P, Montenero AS. Atrial flutter: a focus on treatment options for a common supraventricular tachyarrhythmia. J Cardiovasc Med (Hagerstown) 2007; 8:558-67. [PMID: 17667025 DOI: 10.2459/01.jcm.0000281711.89422.d0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Atrial flutter (AFl), a re-entrant atrial tachycardia, is a cardiac rhythm disturbance that arises in the upper chambers of the heart. This usually non-life-threatening condition can be treated by a number of medical intervention strategies, which include electrical cardioversion, pharmacological therapy, and catheter ablation. These options have been available in clinical practice for a number of years. However, catheter ablation, in the form of radiofrequency catheter ablation and cryo catheter ablation, is increasingly utilised as a first-line treatment option for AFl in certain patients. The purpose of this review article is two-fold: first, to briefly present an overview of AFl and the more familiar treatment options for this arrhythmia, and second to provide more in-depth coverage of catheter ablation technologies as a treatment option for patients with AFl. As part of the latter objective, recent clinical studies documenting the use of radiofrequency catheter ablation and cryo catheter ablation for AFl are presented and their results briefly discussed.
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Affiliation(s)
- Peter Andrew
- ATLAS Medical Research Inc., Saint Lazare, Quebec, Canada
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Abstract
The use of radiofrequency (RF) for selective electro-thermolysis has been found to produce a highly efficient thermal effect on biological tissue. Different from optical energy, RF energy is dependent on the electrical properties of the tissue rather than on concentration of chromophores in the skin for selective thermal destruction of targeted sites. Good results have been obtained with systems that use RF current alone for skin resurfacing, with efficacy comparable to laser resurfacing but with potentially more rapid healing. A related adverse effect is pain accompanying the procedure, due to a high depth of penetration. Another technology integrates RF energy together with optical energy (using lower energies of both forms of energies). These systems have shown efficacy in hair removal for all hair colors and skin types, as well as wrinkle reduction; and may reduce the risk of side effects associated with either RF or optical treatments alone. This article discusses the properties of electrical current in medicine and reviews the studies to date that have evaluated RF energy for dermatological applications.
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Affiliation(s)
- Neil S Sadick
- Weill Medical College of Cornell University, New York, New York, USA.
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Neal S, Ngarmukos T, Lessard D, Rosenthal L. Comparison of the efficacy and safety of two biphasic defibrillator waveforms for the conversion of atrial fibrillation to sinus rhythm. Am J Cardiol 2003; 92:810-4. [PMID: 14516881 DOI: 10.1016/s0002-9149(03)00888-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The overall efficacy of transthoracic biphasic shocks delivered for conversion of atrial fibrillation (AF) has been demonstrated. We compared 2 different energy waveforms, either the biphasic rectilinear (BRL) waveform or the biphasic truncated exponential (BTE) waveform, in the conversion of AF to sinus rhythm. The relation between energy required for the conversion of AF, the type of biphasic waveform, and patient characteristics were examined. Serum levels of cardiac troponin I were measured before and after cardioversion, as well as postprocedural skin erythema and discomfort. In this prospective trial, 101 patients (mean age 61 +/- 15 years, 72 men [71%]) referred for elective electrical cardioversion of AF were randomized to either a BTE or a BRL device. Shocks were delivered in a step-up fashion beginning with 50 J (then 100 J, 200 J, repeat 200 J, and then crossover to 360 J). One hundred patients were successfully converted to sinus rhythm (99% success rate). There was no difference in efficacy at any energy level used, regardless of the duration of the arrhythmia. In addition, there was no difference in cumulative success. Troponin I did not significantly increase after cardioversion, regardless of the total energy used. A positive correlation between skin erythema and skin discomfort after shock (24 to 48 hours) was seen with increasing cumulative energies. There was also a positive trend toward increasing energy requirements as chest circumference and body mass index increased. Thus, biphasic waveforms are safe and effective at converting AF to sinus rhythm. In this study population, there was no clinical difference between the BRL and the BTE waveforms.
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Affiliation(s)
- Susan Neal
- Section of Cardiac Electrophysiology and Pacing, Division of Cardiovascular Medicine, Department of Medicine, UMass Memorial Medical Center, Worcester, Massachusetts 01655, USA
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Abstract
Atrial fibrillation is the commonest sustained cardiac arrhythmia. It accounts for >35% of all hospital admissions for cardiac arrhythmias in the United States. The presence of atrial fibrillation increases the mortality of a population by up to twofold. The risk of stroke increases from 1.5% in patients with atrial fibrillation from 50-59 years of age to up to 23.5% for such patients aged 80-89 years. Although the diagnosis of atrial fibrillation is usually straightforward, effective treatment is not. This article will discuss how rhythm control of atrial fibrillation can best be achieved, the controversy over the rhythm versus rate control, the maintenance of sinus rhythm with antiarrhythmic drugs after cardioversion, and prevention of thromboembolism. Finally, the recent advances in various non-pharmacological approaches for the treatment of atrial fibrillation will be highlighted.
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Cardiac Arrhythmias. Fam Med 2003. [DOI: 10.1007/978-0-387-21744-4_77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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