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A 71-year-old woman underwent VVI pacemaker implantation for complete atrioventricular block 38 years ago at the cardiovascular department of another hospital. In the course of observation, she developed atrial fibrillation. One year ago, she was admitted to hospital for aggravated congestive heart failure and was subsequently treated by a cardiovascular practitioner. She had persistent shortness of breath and lower leg edema, which were treated with increasing doses of oral diuretics. Due to poor treatment outcomes, she was referred to our hospital. Her echocardiography results suggested severe tricuspid regurgitation (TR) and moderate mitral regurgitation. She was also found to have impaired renal function and liver cirrhosis (Stage A of the Child classification), and was admitted. In addition, she had undernutrition with suspected cardiac cachexia. She was first treated by inotrope infusion and central venous hyperalimentation before tricuspid annuloplasty and mitral valvuloplasty were performed. Even though her postoperative management was complicated, she was discharged from our hospital. The conservative treatment with the increased dose of the diuretic for TR-associated right heart failure was prolonged in this patient, leading to severe right heart failure and aggravation of impaired renal function or congestive liver-associated hepatic disorders. Eventually, the patient required operative intervention; however, postoperative management is usually complex, and the operation result may be poor in such patients. We suggest that, from the time when right heart failure can be managed with relatively small doses of diuretics, surgeons should be involved in the care of patients with severe TR who do not require left heart valvular surgery, and should discuss the necessity of surgery earlier than the relevant guidelines suggest, depending on the patient's condition.
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OBJECTIVE:To compare the clinical efficacy and safety of amiodarone and propafenone in the treatment of chron-ic atrial fibrillation cardioversion. METHODS:60 patients with chronic atrial fibrillation cardioversion were randomly divided into propafenone group and amiodarone group. All patients were given conventional treatment,including treating primary disease,con-trolling symptoms,orally giving aspirin,intravenous infusion of GIK,monitoring heart rate,QT interval,P-R interval,QRS time,serum potassium and serum magnesium,etc. On this basis,propafenone group was orally given propafenone 450 mg for con-tinuous 3 months,3 times a day,and then the dose was decreased to 300 mg to maintain the sinus rhythm;amiodarone group was orally given amiodarone 200 mg for continuous 7 d a month,twice a day,and then the dose was decreased to 200 mg or 100 mg to maintain the sinus rhythm. The clinic data in 2 groups was observed,including clinical efficacy,simple drug cardioversion,elec-trical cardioversion,electrical cardioversion power,hospitalization time and incidence of adverse reactions,and the recurrence rate in 48 months was followed up. RESULTS:There were no significant differences in the clinical efficacy,simple drug cardiover-sion,electrical cardioversion,electrical cardioversion power,hospitalization time,incidence of adverse reactions and recurrence rate between 2 groups(P>0.05). CONCLUSIONS:Based on the conventinal treatment,amiodarone and propafenone have similar clinical efficacy and safety in the treatment of chronic atrial fibrillation cardioversion,and both of them can be used as the conven-tional drugs for treating chronic atrial fibrillation cardioversion.
ABSTRACT
La fibrilación auricular (FA) es la arritmia más común en la práctica clínica y por la que más se consulta en los servicios médicos. Recientemente, se ha propuesto un mecanismo de mantenimiento de la FA, el cual consiste en la existencia de uno o varios rotores que activan el tejido a alta frecuencia. La ablación es uno de los tratamientos para la FA, en FA crónica son necesarios patrones de ablación complejos, por lo que actualmente se busca el patrón ideal con un mínimo número de líneas de ablación. En este trabajo se simula la actividad de un rotor en un modelo 2D de tejido auricular humano, bajo condiciones de FA crónica y se localiza su centro de giro (tip). Se proponen y evalúan seis diferentes patrones simples de ablación compuestos por un número reducido de líneas. El estudio demostró que aquellos patrones que atraviesan o encierran el tip del rotor y que adicionalmente se prolongan hasta una frontera de conducción son eficaces en la terminación del rotor.
Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and the most consulted in medical services. Recently it has been proposed a mechanism for maintaining the AF, which consists in one or more rotors activating the tissue at high frequency. Ablation is one of the treatments for AF, for chronic AF is needed complex ablation patterns, so currently it has been looking for an ideal pattern with a minimum number of ablation lines. In this work activity of a rotor was simulated in a 2D model of human atrial tissue, under chronic AF conditions, and the center of rotation (tip) was located. Six different simple ablation patterns composed of a limited number of lines were proposed and evaluated. The study showed that those patterns that passed through or encloses the tip of the rotor and additionally were extended to a conduction boundary are effective in the termination of the rotor.
A fibrilação atrial (FA) é a arritmia mais comum na prática clínica e na consulta que a maioria dos serviços médicos. Recentemente, é proposto um mecanismo para a manutenção da FA, que é a existência de um ou mais rotores que activam o tecido com elevada frequência. A ablação é um tratamento para fibrilação atrial em padrões crônicos de ablação de FA necessárias são complexas, por isso eles estão atualmente buscando o padrão ideal, com um número mínimo de linhas de ablação. Neste documento, a actividade de um rotor é simulada em um modelo em 2D do tecido atrial humano, sob condições de AF crónica e o seu centro de rotação (ponta) está localizado. São propostos e avaliados seis diferentes padrões de ablação individuais compostos de um pequeno número de linhas. O estudo mostrou que as que passam através de padrões ou encerram a ponta do rotor e se estendem para além de um limite de condução são eficazes na cessação do rotor.
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OBJECTIVE: Anticoagulation is a challenge for the prophylaxis of thromboembolic events in elderly patients with chronic atrial fibrillation. Stable anticoagulation is defined as the time within >70% of the therapeutic range. However, the dosage required to achieve stable anticoagulation remains unknown. The aim of this study was to analyze the warfarin dose necessary for the maintenance of stable oral anticoagulation therapy in elderly patients. METHODS: We analyzed 112 consecutive outpatients with atrial fibrillation who were >65 years of age, had received anticoagulation therapy with warfarin for more than 1 year and had a stable international normalized ratio between 2.0 and 3.0 for >6 months. The international normalized ratio was measured in the central laboratory using the traditional method. RESULTS: The patients were stratified according to the following age groups: <75 or >75 years and <80 or >80 years. The mean daily doses of warfarin were similar for patients <75 or >75 years (3.34+1.71 versus 3.26 +1.27 mg/ day, p = 0.794) and <80 or >80 years (3.36+ 1.49 versus 3.15 + 1.23 mg/day, p = 0.433). In 88 (79%) patients, the daily warfarin dose was between 2 and 5 mg/day; in 13 (11%) patients, the daily warfarin dose was <2.0 mg/day; and in 11 (10%) patients, the daily warfarin dose was >5.0 mg/day. The correlation between the daily warfarin dose and the international normalized ratio was 0.22 (p = 0.012). CONCLUSION: Stable anticoagulation was achieved in 80% of patients who received doses of 2 to 5 mg/day of warfarin, and the mean daily dose was similar across the age groups analyzed.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Anticoagulants/administration & dosage , Atrial Fibrillation/blood , Warfarin/administration & dosage , Age Factors , Chi-Square Distribution , Chronic Disease , International Normalized Ratio , Reference Values , Time Factors , Treatment OutcomeABSTRACT
Catheter ablation of atrial fibrillation is an evolving field,especially for chronic atrial fibrillation.Several approaches have been performed in clinic practice,which include circumferential pulmonary vein ablation/isolation,left atrial linear ablation,CFAE ablation,pulmonary vein denervation or stepwise ablation.However,a standard approach has not been established.The total successful rates vary from 21% to 95%.The investigations in the mechanism of chronic atrial fibrillation and methods of three-dimensional mapping,and the usage of new source and technique of ablation will increase the successful rate,decrease the recurrence rate and procedure time.The long-term result of ablation of chronic atrial fibrillation and its impact on the structure and function of heart need further investigations.
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Objective: To evaluate effects of atrioventricular nodal ablation, pacemaker and pharmaco logic agents on ventricular rate control. Methods:Three patients with chronic sustained atrial fibrillation ( AF) were treated by atrioventricular nodal ablation. Fast-slow junctional cardiac rhythm in this course meant the ablation was successful. Unless the ablation was able to get Ⅱ? Ⅱ type or Ⅲ? AVB, R-R intervals ≥3 s, ventricular rate≤40 bpm, it would be canceled. Otherwise implantation of a permanent pacemaker was performed. Results:One patients having complete atrioventricular block and a ventricular rate of 38 -40 bpm had implantation of a permanent pacemaker. Two patients having no atrioventricular block, prolongation of R-R intervals and ventricular rate of 90 - 120 bpm were given antiarrhythmic drugs. Conclusion: Patients with chronic sustained AF can be treaded with atrioventricular nodal ablation, pacemaker and pharmacologic agents effectively.
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Objective To assess the effectiveness and security of warfarin in the treatment of anticoagulation in elderly patients with chronic atrial fibrillation.Methods The patients of chronic atrial fibrillation were divided into two groups randomly warfarin group (group A) and aspirine group (group B). PT and INR of the whole patients were detected, the group A were administed 3 mg/d dose of warfarin. PT and INR were detected every other day. One week later, the dosage of warfarin was increased to 4 mg/d if INR did not reach 2.0-3.0. INR was detected every other week until it reached about 2.0-3.0. Four weeks later, INR was detected every month.. When the patients were inclined to hemorrhagia symptom, their INR was detected immediately. The patients group B were administered aspirin 300 mg orally twice a day . Results In group A, PT was significantly lower than that before treatment, P
ABSTRACT
3 months) were involved in this study PV electrogram was divided into disorganized and organized patterns Segmental PV isolation was performed during AF guided by the earliest PV potential recorded on the basket catheter determined by the lone pause during disorganized pattern or organized PV electrogram The sites with the most disorganized activity during fast and irregular fibrillatory activity had been regarded as ablative target Elimination of PV potential in all PVs during AF, and confirmed by remapping of PV during sinus rhythm or atrial stimuli after cardioversion had been considered as the ablative end point (segmental PV isolation was performed repeatedly if PV potential still existed during sinus rhythm) Results Of the total 76 PVs in 20 patients who achieved PV isolation, 68 (89 5%) PV isolations were performed during AF Reappearance of PV potential occurred in 23(33 8%) during sinus rhythm after cardioversion, and isolation was achieved during sinus rhythm Procedure duration was 5 3?3 7 hours Fluoroscopy time was 2 7?3 8 minutes Recurrence of AF occurred in 11 (55%) patients during the 8?9 month follow up No operation related complication occurred Conclusion Segmental PV isolation for chronic AF is feasible, safe and effective Ablation guided by electrophysiological mapping can result in the elimination of PV potential Remapping of PV and repeated ablation during sinus rhythm after cardioversion is essential