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30.07.2015

Treating atrial fibrillation with rvr, ringing ears causes and cures - .

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Intravenous amiodarone versus verapamil for acute conversion of paroxysmal atrial fibrillation to sinus rhythm. Emergency management of atrial fibrillation and flutter: intravenous diltiazem versus intravenous digoxin. Ventricular rate control in chronic atrial fibrillation during daily activity and programmed exercise: a crossover open-label study of five drug regimens. Efficacy of agents for pharmacologic conversion of atrial fibrillation and subsequent maintenance of sinus rhythm: a meta-analysis of clinical trials. Use of transesophageal echocardiography to guide cardioversion in patients with atrial fibrillation.
Managing chronic atrial fibrillation: a Markov decision analysis comparing warfarin, quinidine, and low-dose amiodarone.
Risk for clinical thromboembolism associated with conversion to sinus rhythm in patients with atrial fibrillation lasting less than 48 hours.
Left atrial chamber and appendage function after internal atrial defibrillation: a prospective and serial transesophageal echocardiographic study. Cost-effectiveness of transesophageal echocardiographic-guided cardioversion: a decision analytic model for patients admitted to the hospital with atrial fibrillation. Time of occurrence, duration, and ventricular rate of paroxysmal atrial fibrillation: the effect of digoxin. Comparison of intravenous ibutilide versus procainamide for the rapid termination of atrial fibrillation or flutter. Efficacy and proarrhythmic hazards of pharmacologic conversion of atrial fibrillation: prospective comparison of sotalol versus quinidine. Effectiveness of loading oral flecainide for converting recent-onset atrial fibrillation to sinus rhythm in patients without organic heart disease or with only systemic hypertension. Conversion of recent-onset atrial fibrillation by a single oral loading dose of propafenone or flecainide. Oral propafenone to convert recent-onset atrial fibrillation in patients with and without underlying heart disease.
A comparison of cardioversion of atrial fibrillation using oral amiodarone, intravenous amiodarone and DC cardioversion.
Intravenous amiodarone in treatment of recent-onset atrial fibrillation: results of a randomized, controlled study. Efficacy, safety, and determinants of conversion of atrial fibrillation and flutter with oral amiodarone.
Effectiveness of amiodarone and electrical cardioversion for chronic rheumatic atrial fibrillation after mitral valve surgery.
Comparison of sotalol with digoxin-quinidine for conversion of acute atrial fibrillation to sinus rhythm (the Sotalol-Digoxin-Quinidine Trial).
Sotalol versus quinidine for the maintenance of sinus rhythm after direct current conversion of atrial fibrillation. Acute treatment of recent-onset atrial fibrillation and flutter with a tailored dosing regimen of intravenous amiodarone. Efficacy of intravenous ibutilide for rapid termination of atrial fibrillation and atrial flutter: a dose-response study. Although many patients with atrial fibrillation experience relief of symptoms with control of the heart rate, some patients require restoration of sinus rhythm. Initial treatment is directed at controlling the ventricular rate, most often with a calcium channel blocker, a beta blocker, or digoxin. Noncardiac conditions that can predispose patients to develop atrial fibrillation include hyperthyroidism, hypoxia, alcohol intoxication, and surgery.4The ECG is the mainstay for diagnosis of atrial fibrillation (Figure 1). External direct current (DC) cardioversion is the most effective means of converting atrial fibrillation to sinus rhythm. Digoxin, which is perhaps the oldest form of therapy for atrial fibrillation, has an onset of action between 30 minutes and two hours, with peak effect in two to six hours.
It is important to note that all methods of pharmacologic cardioversion are associated with proarrhythmic risks.


Treatment For Afib With Rvr Treatment For Afib Ablation Acls Treatment For Afib : lerning About this.
Medical or electrical cardioversion to restore sinus rhythm is the next step in patients who remain in atrial fibrillation. Processes that increase atrial size, such as valvular heart disease, ischemic heart disease and dilated cardiomyopathy, provide a greater surface area for the development of multiple reentrant wavelets.
The incidence of polymorphic ventricular tachycardia may be as high as 2 percent, even with the use of oral agents. In an outpatient clinic where intravenous administration of medications and electrocardiographic and blood pressure monitoring are available, the heart rate may be controlled initially with intravenous medications. Several advances have been made in antiarrhythmic medications, including the development of ibutilide, a class III antiarrhythmic drug indicated for acute cardioversion of atrial fibrillation. Therefore, we recommend that medical cardioversion be performed only in a monitored setting with an accessible defibrillator. Oral agents may be used in ambulatory patients, provided that symptoms do not warrant prompt rate control.If atrial fibrillation has been present for less than 48 hours, it is not necessary for the patient to undergo anticoagulation before cardioversion. Anticoagulation with warfarin should be used for three weeks before elective cardioversion and continued for four weeks after cardioversion. The tracing demonstrates the absence of P waves (long arrow), as well as the presence of the fine f waves of atrial fibrillation (short arrows). In addition, the effectiveness of digoxin varies with the individual patient's autonomic tone.Digoxin is not effective in converting atrial fibrillation to sinus rhythm. The recommendations provided in this two-part article are consistent with guidelines published by the American Heart Association and the Agency for Healthcare Research and Quality.
Until the results of several large-scale randomized clinical trials are available, the decision to choose cardioversion or maintenance of sinus rhythm must be individualized, based on relief of symptoms and reduction of the morbidity and mortality associated with atrial fibrillation.Atrial fibrillation is the most common sustained arrhythmia encountered in primary care practice.
This may account for the mixed efficacy of our current antiarrhythmic medications.Increased sympathetic activity and increased vagal tone decrease the atrial refractory period, as does thyrotoxicosis. If atrial fibrillation has been present for more than 48 hours or if the onset is unknown, an initial three- to six-week course of anticoagulation is recommended. It is worth to note that unnecessary treatment for afib with rvr is not required if the patient is having mild symptoms and no loss of quality of life is experienced by. According to the Framingham Heart Study,1 atrial fibrillation has a prevalence of 4 percent in the adult population.
Patients with chronic atrial fibrillation (including paroxysmal fibrillation) and at least one risk factor for thromboembolism should be considered for chronic anticoagulation.Three large, prospective, randomized trials currently under way address the question of rate control versus rhythm control. Likewise, atrial fibrillation may be terminated by increasing the conduction velocity or increasing the refractory period of the atrial tissue. Until the results of these trials are available, the decision for patients to undergo cardioversion for atrial fibrillation and to attempt to maintain sinus rhythm should be based on the patient's symptoms and risk for thromboembolism.
Antiarrhythmic medications may be of benefit by prolonging the refractory period of atrial tissue, thus preventing propagation of multiple reentry wavelets in the atria. Food and Drug Administration for use in hypertension, angina pectoris and acute myocardial infarction, it is commonly used for rate control in atrial fibrillation.Rate control is necessary in all patients. Torsades de pointes is a major side effect in patients who undergo therapy with quinidine, as it is with procainamide therapy. In addition, when the ventricular response to atrial fibrillation is very rapid (more than 200 beats per minute), variability of the R-R interval can frequently be seen more easily using calipers on a paper tracing.Atrial flutter is included in the spectrum of supraventricular arrhythmia. Although many patients with atrial fibrillation are symptomatic, some patients remain asymptomatic. Unfortunately, antiarrhythmic medications also decrease conduction velocity, therefore favoring atrial fibrillation, which may account for the mixed efficacy of antiarrhythmic medications in maintaining sinus rhythm.If the decision is made for a patient to undergo cardioversion, the procedure should be performed as close to the onset of arrhythmia as possible.
This rhythm disturbance is usually distinguishable by its more prominent saw-tooth wave configuration and slower atrial rates (Figure 2). Thus, it is often difficult to estimate the onset, duration or severity of atrial fibrillation by the history alone. Patients with paroxysmal atrial fibrillation do not require cardioversion by definition, although they may require medication to control heart rate and often require antiarrhythmic agents to maintain sinus rhythm.In patients with persistent atrial fibrillation, several intravenous and oral pharmacologic alternatives to DC cardioversion are available.


Outpatient treatment of recent-onset atrial fibrillation with the “pill-in-the-pocket.
Atrial fibrillation should also be distinguished from atrial tachycardia with variable atrioventricular block, which usually presents with an atrial rate of approximately 150 beats per minute.
Although this method is safe and effective, it requires the placement of transvenous shocking coils into the right ventricle and the right atrium. In this condition, the atrial rate is regular (unlike the irregular disorganized f waves of atrial fibrillation), but conduction to the ventricles is not regular. Management includes heart rate control, rhythm control, anticoagulation therapy, or a combination of these strategies.Initial treatment also depends on the course of atrial fibrillation.
However, the risk is very small in patients who have been in atrial fibrillation for less than 48 hours. Unlike amiodarone and sotalol, it is currently indicated for the acute termination of atrial fibrillation and flutter. There are no data to support outpatient cardioversion with high- or moderate-dose oral antiarrhythmics without the use of electrocardiographic monitoring and close observation. It is worth to note that unnecessary treatment for afib with rvr is not required if the patient is having mild symptoms and no loss of quality of life is experienced by the patient. Ibutilide prolongs repolarization of the atrial tissue by enhancing the slow inward depolarizing Na+ current in the plateau phase of repolarization. Although all calcium channel blockers can cause hypotension, verapamil should be used with particular caution because of the possibility of prolonged hypotension as a result of the drug's relatively long duration of action.Beta blockers such as propranolol (Inderal) and esmolol (Brevibloc) may be preferable to calcium channel blockers in patients with myocardial infarction or angina, but they should not be used in patients with asthma. Paroxysmal atrial fibrillation is defined as recurrent episodes of spontaneously terminating atrial fibrillation.
Ibutilide has little to no effect on the conduction velocity of the atrial tissue.33 The electrophysiologic actions of ibutilide make it difficult for the atrial tissue to support multiple wavelets of reentry. Persistent atrial fibrillation is defined by persistence of the arrhythmia until cardioversion is performed. Classification of atrial fibrillation (AF) begins with distinguishing a first detectable episode, irrespective. A slower ventricular response rate also allows more filling time for the heart and, thus, improved cardiac output.14 However, the benefits of long-term treatment with calcium channel blockers or beta blockers should be carefully weighed against the negative inotropic effects. Early successful cardioversion may also reduce the incidence of recurrent atrial fibrillation.3Medical cardioversion may be appropriate in certain situations, especially when adequate facilities and support for electrical cardioversion are not available or when patients have never been in atrial fibrillation before.
Anticoagulation with warfarin (Coumadin) should be continued for four weeks after cardioversion.After anticoagulation is initiated, quinidine sulfate (Quinidex), flecainide (Tambocor), or propafenone (Rythmol) may be used to attempt pharmacologic conversion. Atrial fibrillation (AF or A-fib) is the the vast majority common cardiac arrhythmia (irregular heart of. Amiodarone is the recommended agent in patients with a low ejection fraction (below 0.35) or structural heart disease. Afib Treatment The cornerstones of atrial fibrillation management are rate control and anticoagulation [25] and rhythm control for those symptomatically limited by AF.
Patients should be monitored closely because quinidine, propafenone, and amiodarone may increase the International Normalized Ratio when they are used with warfarin. Synchronized external direct-current cardioversion is performed with the pads placed anteriorly and posteriorly (over the sternum and between the scapulae) at 100 joules (J). If patients cannot be moved, the pads can be applied over the right sternal border and left lateral chest wall.3Patients with atrial fibrillation at a ventricular rate of less than 150 beats per minute who are hemodynamically stable can be initially treated with drugs for ventricular rate control and intravenously administered heparin for anticoagulation (see part II for more information). In elderly patients with longstanding atrial fibrillation, repeated attempts at cardioversion may be counterproductive. The chances of reverting to and maintaining sinus rhythm are lower with longer duration of atrial fibrillation and decrease to particularly low levels when atrial fibrillation has been present for more than one year. The success rate for electrical cardioversion is 90%.Medical cardioversion is a convenient and reasonable alternative in some patients, but it does not always terminate atrial fibrillation.



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