ABSTRACT
BACKGROUND: The aim of this study was to compare the outcome of 3 months vs. 18 months of amiodarone treatment after atrial fibrillation (AF) conversion in patients who experienced the first episode of persistent AF. METHODS: We included 51 patients who experienced the first episode of persistent AF receiving amiodarone (600 mg) daily for 4-6 weeks. If AF persisted, electrical cardioversion (ECV) was performed. All patients received amiodarone (200 mg daily) for 3 months and then were randomized to amiodarone (Group I) or placebo (Group II) and followed for 15 months. The control group comprised 9 untreated patients undergoing ECV. Treatment effectiveness was evaluated using a Bayesian model. RESULTS: Eighteen months after AF reversion, 22 (81.5%) patients in Group I, 13 (54.2%) patients in Group II, and 1 (11.1%) patient in the control group remained in sinus rhythm. No differences were found between Group I patients who required ECV and Group II patients. Sinus rhythm was preserved in all Group I patients when it was achieved during amiodarone administration. Limiting adverse effects occurred in 3 (11.1%) patients in Group I. CONCLUSIONS: In patients regaining sinus rhythm after the first episode of persistent AF, a 3-month amiodarone treatment after reversion is a reasonable option for rhythm control.
Subject(s)
Amiodarone/administration & dosage , Anti-Arrhythmia Agents/administration & dosage , Atrial Fibrillation/therapy , Electric Countershock , Heart Conduction System/drug effects , Heart Rate/drug effects , Aged , Aged, 80 and over , Argentina , Atrial Fibrillation/diagnosis , Atrial Fibrillation/physiopathology , Bayes Theorem , Combined Modality Therapy , Disease-Free Survival , Double-Blind Method , Drug Administration Schedule , Echocardiography, Doppler , Electric Countershock/adverse effects , Electrocardiography, Ambulatory , Female , Heart Conduction System/physiopathology , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Recurrence , Time Factors , Treatment OutcomeSubject(s)
Amiodarone/administration & dosage , Anti-Arrhythmia Agents/administration & dosage , Atrial Fibrillation/therapy , Electric Countershock , Heart Rate/physiology , Administration, Oral , Atrial Fibrillation/physiopathology , Dose-Response Relationship, Drug , Electrocardiography , Humans , Injections, Intravenous , Treatment OutcomeABSTRACT
OBJECTIVE: The study analyzed the role of different variables that determine long-term sinus rhythm maintenance in patients with persistent atrial fibrillation who are treated with amiodarone. BACKGROUND: It has been recognized that different factors influence long-term sinus rhythm preservation after the conversion of persistent atrial fibrillation. Although the duration of the arrhythmia appears to be the most important factor, consistent information regarding the role of the mode of arrhythmia conversion (pharmacologic or electric) is still lacking. METHODS: One hundred and forty one anticoagulated patients with persistent atrial fibrillation (median duration 8 months, percentiles 25 and 75: 2-24) were treated for 4 weeks with oral amiodarone (600 mg/day). Those in whom the arrhythmia persisted underwent electric cardioversion. After restoration of normal sinus rhythm (either pharmacologic or electric), all patients received a daily dose of amiodarone (200 mg) and were followed for a median of 19 months (percentiles 25 and 75: 8-34 months). RESULTS: Sixty eight patients (48.22%) regained sinus rhythm during the initial period of amiodarone treatment with 600 mg/day (Group I) and 73 (51.78%) required electric cardioversion (Group II). During the entire follow-up, atrial fibrillation relapsed in 63 patients: 17 (25%) in Group I and 46 (63%) in Group II. Recurrences of the arrhythmia were strikingly less frequent in patients whose atrial fibrillation lasted 12 months or less (33/103, 32.3%) than in those whose atrial fibrillation lasted more than 12 months (30/38, 78.94%). In the multivariate analysis, the mode of reversion (HR, 0.37; CI, 0.21-0.65) and the duration of the arrhythmia (HR, 2.55; CI, 1.54-4.20) were the determinants for long-term sinus rhythm maintenance. Age, sex, left atrium size, left ventricle diameter, and the shortening fraction did not significantly influence the rate of arrhythmia recurrence. Among the 141 patients included in the study, 113 patients were followed for at least 1 year, and cardiac rhythm was assessed at this time. Of these, only 1 of 48 patients (2.1%) in Group I was in atrial fibrillation, in marked contrast with 18 of 65 patients (27.8%) in Group II (RR, 0.075; 95% CI, 0.01-0.54). CONCLUSIONS: In patients with persistent atrial fibrillation, long-term preservation of sinus rhythm under chronic amiodarone treatment may be anticipated when the arrhythmia lasts 12 months or less and/or its reversion is obtained pharmacologically. We may confidently assume that these two factors have a beneficial additive influence on the outcome.
Subject(s)
Amiodarone/therapeutic use , Anti-Arrhythmia Agents/therapeutic use , Arrhythmia, Sinus/drug therapy , Atrial Fibrillation/drug therapy , Adult , Aged , Arrhythmia, Sinus/therapy , Atrial Fibrillation/therapy , Electric Countershock , Electrocardiography , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies , Recurrence , Time Factors , Treatment OutcomeABSTRACT
La detección de compromiso miocárdico precoz en la enfermedad de Chagas es muy importante para la elaboración de estrategias terapéuticas y/o preventivas. Para ello se utilizaron diferentes procedimientos de diagnóstico no invasivo. Con el propósito de evaluar en forma comparativa la capacidad de detectar anormalidades miocárdicas subclínicas se analizaron hallazgos en el ecocardiograma bidimensional, la prueba ergométrica graduada, la prueba de ajmalina y el electrocardiograma ambulatorio de 24 horas con sistema Holter. Se estudiaron 140 pacientes (78 varones y 62 mujeres) con serología positiva para la enfermedad de Chagas. Los resultados de este estudio muestran que la prueba de ajmalina es un marcador más sensible de daño miocárdico que el ecocardiograma bidimensional, el Holter o la prueba ergométrica y permite detectar el compromiso miocárdico chagásico en etapas más tempranas, aunque en algunos pacientes es posible demostrar anormalidades ecocardiográficas en presencia de una prueba de ajmalina negativa
Subject(s)
Humans , Male , Female , Adolescent , Adult , Ajmaline/administration & dosage , Ajmaline/therapeutic use , Chagas Cardiomyopathy/diagnosis , Chagas Disease/immunology , Echocardiography , Electrocardiography, AmbulatoryABSTRACT
La detección de compromiso miocárdico precoz en la enfermedad de Chagas es muy importante para la elaboración de estrategias terapéuticas y/o preventivas. Para ello se utilizaron diferentes procedimientos de diagnóstico no invasivo. Con el propósito de evaluar en forma comparativa la capacidad de detectar anormalidades miocárdicas subclínicas se analizaron hallazgos en el ecocardiograma bidimensional, la prueba ergométrica graduada, la prueba de ajmalina y el electrocardiograma ambulatorio de 24 horas con sistema Holter. Se estudiaron 140 pacientes (78 varones y 62 mujeres) con serología positiva para la enfermedad de Chagas. Los resultados de este estudio muestran que la prueba de ajmalina es un marcador más sensible de daño miocárdico que el ecocardiograma bidimensional, el Holter o la prueba ergométrica y permite detectar el compromiso miocárdico chagásico en etapas más tempranas, aunque en algunos pacientes es posible demostrar anormalidades ecocardiográficas en presencia de una prueba de ajmalina negativa (AU)
Subject(s)
Humans , Male , Female , Adolescent , Adult , Chagas Cardiomyopathy/diagnosis , Ajmaline/therapeutic use , Ajmaline/administration & dosage , Echocardiography , Electrocardiography, Ambulatory , Chagas Disease/immunologyABSTRACT
En la actualidad, los problemas prioritarios de salud no son ya los de provisíon de agua potable o saneamiento ambiental sino, entre otros, los accidentes y las cardiopatías. Para optimizar los efectos de la labor preventiva, el médico de familia se vale de cuatro claves que aseguran un excelente cuidado: continuidad, intimidad, accesibilidad y confiabilidad. Por lo tanto, ofrece a la comunidad la alternativa de la atención integral de los problemas de salud. La familia es, en definitiva, el eje del trabajo del especialista en medicina familiar en oposición a la atención despersonalizada y fragmentaria del paciente que aún hoy es norma en el consultorio tradicional
Subject(s)
Health Services Accessibility , Comprehensive Health Care , Continuity of Patient Care , Medicine , Physicians, Family , Preventive MedicineABSTRACT
En la actualidad, los problemas prioritarios de salud no son ya los de provisíon de agua potable o saneamiento ambiental sino, entre otros, los accidentes y las cardiopatías. Para optimizar los efectos de la labor preventiva, el médico de familia se vale de cuatro claves que aseguran un excelente cuidado: continuidad, intimidad, accesibilidad y confiabilidad. Por lo tanto, ofrece a la comunidad la alternativa de la atención integral de los problemas de salud. La familia es, en definitiva, el eje del trabajo del especialista en medicina familiar en oposición a la atención despersonalizada y fragmentaria del paciente que aún hoy es norma en el consultorio tradicional (AU)
