- It lasts less than 7 days (usually minutes, hours) and stops on its own (disappears).
- A persistent form of atrial fibrillation – its duration is more than 7 days, it is stopped only with medication or electric cardioversion. The latter is the restoration of rhythm with the help of an electrical impulse with a frequency of 250 – 400 J.
- A persistent form of atrial fibrillation – can not be eliminated.
In addition to this classification, doctors distinguish a permanent form (for example, more than a month, a year in which cardioversion was ineffective or not performed) and the first detected atrial fibrillation.
- brady (ventricular contraction occurs at a rate of 60 or less per minute);
- normal (ventricular contraction occurs at a rate of 60 – 90 per minute);
- tachysystolic (contraction of the ventricles occurs at a speed of 90 – 200 beats per minute).
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- EHRA >
- Types of disease
- Symptoms of the disease
- Differential diagnostics
- Patient survey
- Atrial fibrillation treatment
- Purpose of treatment
- Symptoms of the disease
- Contraindications for electropulse therapy
- Recovery of the heart rhythm by the discharge of electric current: indications and procedure
- Cardioversion, defibrillation: types, indications, conduct, result and consequences
- Cardioversion, defibrillation: types, indications, conduct, result and consequences
- Diet for atrial fibrillation
- What is helpful?
- Cardioversion for atrial fibrillation reviews
In 2010, the European Society of Cardiologists proposed a classification of EHRA (European Heart Rhythm Association), based on the severity of symptoms of atrial fibrillation:
- Grade I – absence of symptoms;
- Grade II – mild symptoms that do not violate habitual life;
- Grade III – severe symptoms that cause difficulties for daily activity;
- IV class – disabling symptoms, the possibility of self-care is limited.
Arrhythmia can be detected due to the manifestation of the following symptom:
- a feeling of palpitations;
- rapid breathing or shortness of breath;
- weakness of the body;
- loss of creation;
- a feeling of pressure or pain in the chest area.
It is worth noting that there are cases when patients for a very long period of time do not observe any unusual or uncomfortable conditions for them that can indicate the presence of a disease. Therefore, the appointment with a specialist is too late.
Atrial fibrillation is a disease in which normal heart rhythm is disturbed. Normally, the heart contracts at regular intervals to effectively expel blood. The correct rhythm is set thanks to the sinus node, after which the atria and ventricles begin to contract in the same rhythm – sinus.
Types of disease
There are several types of atrial dysfunction:
- Paroxysmal atrial fibrillation is a more frequent form in which acute attacks are observed against a background of normal heart rhythm. Such episodes with timely assistance are stopped in a day, sometimes the attack goes away on its own.
- The persistent type is characterized by a longer duration – 7-10 days and the attack cannot be stopped on its own. With this form, medication or even surgical treatment is necessary (when the disease is delayed for 5-7 months).
- The constant form is called normal heart rhythm, alternating with arrhythmia. The duration of the disease is from 1 year to several years. Since it is impossible to completely restore the normal rhythm, this form is often considered chronic.
According to the clinical course, atrial fibrillation can be overt and asymptomatic.
Symptoms of the disease
Symptoms of atrial cardiac arrhythmias vary depending on the form of the disease and the type of comorbidity. In addition, the signs of atrial cardiac arrhythmias depend on the individual characteristics of a particular patient (cardiovascular system performance).
The main symptoms of atrial fibrillation:
- weakness in the body, increased fatigue;
- heart palpitations;
- autonomic disorders (hyperhidrosis of the palms and feet, cystalgia, chills or fever, pain or short tingling in the sternum, pallor of the skin);
- dizziness, up to loss of consciousness;
- pulse deficiency, which manifests itself in a mismatch in the number of pulse waves and strokes of the heart contractions;
- panic attacks.
The danger of the disease is that the patient alone can not determine the symptoms of atrial fibrillation and treatment in this case will be delayed and not very effective. In the absence of timely diagnostic procedures, the disease becomes chronic, which is practically not subject to therapy.
It is the doctor who will diagnose this disease. To do this, he will need to perform a number of procedures.
It is necessary to identify possible causes of atrial fibrillation, predisposing factors, to find out related diseases. Further, information about arrhythmia is needed – the limitation of the onset of the first symptom, how the patient feels a rhythm disturbance, its duration, when it appears, how it stops, whether the treatment was carried out, which drugs are taking and their effectiveness.
- upon palpation of the pulse during an attack, it will be irregular;
- the difference between the heart rate measured on the radial and carotid arteries will be revealed;
- with auscultation of the heart, the changing volume of the I tone will attract attention;
- blood pressure measurement.
- general and biochemical blood test;
- general urine analysis;
- level of thyroid hormones (triiodothyronine, thyroxine), pituitary gland (thyroid-stimulating hormone);
- lipid profile;
- troponins I, T.
- possible daily monitoring of the electrocardiogram – holter;
- chest x-ray;
- transesophageal electrophysiological examination;
- load test (treadmill test);
- magnetic resonance imaging of the heart.
There are 4 electrocardiographic signs of atrial fibrillation (only a doctor can evaluate them):
- the absence of P waves in all leads (they reflect the reduction of the atria);
- the presence throughout the cycle of random waves f having various shapes and amplitudes. Best of all waves f are registered in assignments of V1, V2, II, II, aVF;
- irregularity of the ventricular QRS complexes, that is, an irregular ventricular rhythm;
- QRS complexes are in most cases unchanged, without defects and broadening.
Echocardiography allows you to determine the size of the heart, chambers, visualize intracardiac blood clots, evaluate blood flow, pressure in the heart and blood vessels, and observe in real time the unevenness of myocardial contractions.
Atrial fibrillation must be differentiated from other cardiac arrhythmias, for example, from supraventricular arrhythmias – tachycardia (frequent reduction) of the atria, atrial flutter. Symptoms in these diseases can be the same. An important sign of tachycardia is that it will disappear with the use of vagal samples. Vagus tests are aimed at stimulating the parasympathetic nervous system (this will lead to a reduction in heart rate). These include:
- straining at the height of inspiration (Valsalva test);
- immersion of the face and hands in cold water;
- carotid sinus massage;
- hanging the upper body from the bed;
- pressure on the eyeballs.
If the symptoms disappeared during vagal tests, it was atrial tachycardia.
In order to distinguish atrial flutter from fibrillation, it is necessary to remove the electrocardiogram. On it, determine the frequency of atrial contraction (by the frequency of the waves f), with flutter, the frequency will be up to 350 per minute.
Atrial fibrillation treatment
Purpose of treatment
There are 2 strategies for treating AF:
- the first is reduced to rhythm control: restoration of normal heart rhythm with subsequent prevention of relapse;
- the second sets the task of controlling the heart rate – preserving AF, reducing heart rate, lifelong anticoagulant therapy.
The strategy depends on the severity of clinical manifestations, on how the patient himself suffers from atrial fibrillation attacks, whether they worsen the quality of his life, the patient’s age, life expectancy, tolerance of drugs against arrhythmia, and many other factors. The choice of therapy is always individual.
- first arising atrial fibrillation;
- paroxysmal MA, lasting less than two days, not amenable to medical cardioversion at the prehospital stage;
- paroxysmal MA, lasting less than two days and accompanied by a ventricular contraction rate of more than 150 per minute, acute circulatory disorders or an attack of angina pectoris;
- paroxysmal MA lasting more than two days;
- persistent MA;
- a constant form of MA, with severe tachycardia (heart rate of more than 150 beats per minute), acute circulatory disorders or angina pectoris;
- the presence of thromboembolic and hemorrhagic complications.
Exclusion of factors provoking the development of an attack of atrial fibrillation in a particular patient. A patient with an already established diagnosis knows after what events he has paroxysm. This may be alcohol use, stress, intense physical activity, or other factors.
Treatment of atrial fibrillation (MA) includes two areas:
- therapy directly rhythm disturbances;
- prevention of complications caused by thromboembolism.
Arrhythmia can be treated in two ways:
- restoration and preservation of sinus rhythm;
- ventricular rhythm control while maintaining irregular rhythm.
A frequent method of non-drug treatment of this arrhythmia is catheter ablation, which is the destruction of electrically active tissue in the atria. It is carried out using a special catheter, which is inserted through a vein into the heart cavity. After such an operation, the risk of recurrence of arrhythmia during the year is up to 50%.
Another operation is widespread: the destruction of the atrioventricular connection, through which impulses from the atria randomly excite the ventricles. At the same time, a two-chamber pacemaker is installed, which allows you to simulate the physiological work of the heart and control the frequency of ventricular contractions in patients with MA.
It is impossible to cure atrial fibrillation only with traditional medicine. However, their reasonable use will improve the condition of the heart muscle, normalize the electrolyte content in the blood.
The water infusion of dill seeds and the alcohol tincture of yarrow grass helps with this disease. It is very popular for heart diseases, including atrial fibrillation, the following recipe: take equally honey, dried apricots, raisins, peeled walnuts and lemons with peel, chop, mix, take one tablespoon on an empty stomach.
Symptoms of the disease
Contraindications for electropulse therapy
In the case when it comes to defibrillation, there are no contraindications, since defibrillation is performed according to vital indications, that is, the patient needs to save his life no matter how dangerous electric pulse therapy is.
In the case of cardioversion, everything is not so simple. Firstly, the patient should not perform electric cardioversion if there is evidence that he is taking cardiac glycosides (digoxin), since intoxication with these drugs is likely, and their constant circulation in the blood can lead to ventricular fibrillation during cardioversion.
Secondly, cardioversion should be postponed as planned for a patient with decompensated chronic heart failure (increased shortness of breath, decreased tolerance to the minimum household load, increased edema, etc.) until it is unloaded with diuretics and other drugs.
Thirdly, the procedure is contraindicated in patients with acute infectious diseases accompanied by fever.
Recovery of the heart rhythm by the discharge of electric current: indications and procedure
Heart rhythm disturbances can be life threatening. In some cases, the patient is unaware of the presence of arrhythmias, in others – this condition leads to a serious attack that requires immediate medical attention.
If the heart rhythm is broken so much that the likelihood of death is increased, doctors resort to the help of a defibrillator. Before using this measure, you must make sure that it is necessary.
Arrhythmia – a pathological condition in which a violation of heart rate occurs
Rhythm disturbance is one of the most common cardiac pathologies. Arrhythmia can be either a separate disease, or one of the manifestations. Most often, arrhythmia occurs against the background of an existing disease. Most often, atrial fibrillation occurs, in which different parts of the myocardium contract at different speeds, intervals and intensities.
The restoration of the rhythm by the discharge of an electric current is carried out only if other methods of combating arrhythmia do not help. The heart contracts in such a way that blood flows most productively into the arteries and veins. If the muscle fibers of the atria begin to contract randomly, the pumping function of the heart decreases, the blood does not enter the ventricles, and then into the arteries, which leads to various complications.
Since rhythm disturbances are usually the result of various diseases, this condition can occur for the following reasons:
- Ischemia and myocardial infarction. Coronary heart disease often leads to a heart attack, since it is accompanied by oxygen starvation of the myocardium, which can provoke tissue death. In this case, blood flow to the myocardium is disturbed, this provokes arrhythmia.
- The use of large doses of alcohol. Alcohol negatively affects the condition of the heart and blood vessels. When drinking a large amount of alcoholic beverages, an arrhythmia attack develops. If you already have a serious disease of the cardiovascular system, this condition can be fatal.
- Hormonal disorders. In people with thyroid disease, diabetes and other hormonal problems, heart rhythm disturbances are quite common. The hormonal background is responsible for the work of many internal organs, so malfunctions lead to serious complications.
- Atrial fibrillation can be asymptomatic and detected only during the examination (ECG). Signs of arrhythmia are discomfort in the chest, tachycardia. A person feels a fluttering heart, a fast heartbeat, a fade, etc.
An electric current discharge is indicated for fibrillation and tachyarrhythmia
Eliminating cardiac arrhythmias using an electrical impulse is called cardioversion. It is carried out differently depending on the condition of the patient and the urgency of the procedure.
As you know, the heart contracts due to the sinus node, which delivers electrical impulses and causes contraction of the myocardium. Cardioversion works on the same principle. With the help of current, the heart is forced to contract at the right rhythm and with the necessary frequency.
This procedure may have consequences and contraindications that in urgent cases (when cardiac arrest) it is necessary, as it is part of resuscitation procedures.
Cardioversion is required in the following cases:
- Atrial fibrillation. In this case, the impulses to the myocardium come unevenly, muscle fibers contract very quickly and randomly, while unproductive. The cause may be cardiac pathologies (heart failure, cardiosclerosis, heart disease). The likelihood of sudden death with atrial fibrillation is very high, so cardioversion is often recommended.
- Ventricular fibrillation. This is a dangerous condition in which the walls of the ventricles contract with a high frequency (300 beats per minute), but the pumping function of the heart stops. Blood does not flow to organs and tissues, which leads to the death of the patient within 10 minutes if medical care is not provided.
- Atrial tachycardia. Atrial tachycardia is quite common, especially in older people. As a rule, the forecast is favorable. This disease is not considered to be life-threatening, but in some cases there are complications and further rhythm disturbances that must be corrected by electric shock.
- Ventricular tachycardia. This is one of the most unfavorable rhythm disturbances that occur during myocardial infarction. The risk of sudden cardiac arrest is very high, so the patient needs urgent medical attention.
Cardioversion can also be scheduled. In this case, the patient is prepared for the procedure.
Cardioversion is performed in the intensive care unit. In this case, an apparatus called a cardioverter is used. It is equipped with electrodes that can be superimposed on the chest and back of the patient in the projection of the heart, or on the left half of the chest and under the right collarbone. In addition, there is a window on the device’s case in which the doctor can see the cardiogram complexes obtained by applying electrodes to the patient’s chest.
Separately, the equipment of the chamber in which the procedure is carried out should be noted. The doctor should have a kit at hand for resuscitation in the event of clinical death, in particular, a tube for intubating the patient for mechanical ventilation, solutions of adrenaline, mesatone, prednisolone and other emergency care.
The procedure itself is carried out as follows. The patient is injected into a state of drug sleep using intravenous or general anesthesia (fentanyl, promedol, diazepam, etc.). A venous catheter is inserted into the patient’s vein to ensure stable access to the venous bed. Further, the electrode application sites are wiped with an alcohol solution for degreasing, the surface of the electrodes is lubricated with a special gel, and the doctor forces the electrodes on the patient’s chest.
If the patient continues to have arrhythmia, after a maximum discharge of 360 Joules, an antiarrhythmic drug should be administered, and thus administering the drug and discharging the maximum power up to three times. In the absence of effect, cardioversion is considered ineffective.
The technique of cardioversion with supraventricular arrhythmias (atrial fibrillation) is as follows:
- Rank 50 (100) J,
- No effect – discharge 100 (200) J,
- No effect – discharge 200 (360) J,
- No effect – the introduction of an antiarrhythmic drug,
- No effect – 360 J discharge – drug administration – 360 J discharge – drug administration,
- There is no effect after the fourth discharge of maximum power – cardioversion is ineffective,
- There is an effect after discharge, that is, the sinus rhythm is restored – ECG recording in 12 leads.
In time, cardioversion (atrial defibrillation) can take various intervals – from several minutes to an hour, without causing the patient unpleasant sensations due to the action of anesthesia. Without the latter, the procedure is extremely painful and difficult to tolerate for the patient.
Cardioversion, defibrillation: types, indications, conduct, result and consequences
Electrical restoration of sinus rhythm by cardioversion is indicated in the presence of supraventricular arrhythmias (supraventricular) types, as well as in certain cases of atrial fibrillation, which includes atrial fibrillation and atrial flutter. It is with such rhythm disturbances that synchronization with the ventricular complexes is necessary, therefore defibrillation is not only ineffective here, but also dangerous.
These types of arrhythmias – paroxysmal supraventricular tachycardia, atrial tachyarrhythmia, tachycardia from AV (atrioventricular) connection, atrial fibrillation – are characterized by the appearance of a circulating excitation wave of the re-entry type, attenuation or complete cessation of the sinus node (pacemaker), 1st rhythm as well as the presence in some cases of a chaotic contraction of all muscle fibers in the atrial tissue, as is the case with atrial fibrillation.
The main indication for cardioversion is the presence of a patient’s paroxysm (sudden attack) of tachycardia or tachyarrhythmia, which is not stopped by the usual administration of medications.
Separately, it is necessary to highlight the indications for electrical cardioversion with atrial fibrillation:
- Ineffectiveness of drug cardioversion (administration of antiarrhythmic drugs) in case of a paroxysmal form of arrhythmia in individuals with signs on the cardiogram of myocardial ischemia, acute myocardial infarction, as well as with a marked decrease in blood pressure (hypotension) and severe heart failure,
- The presence of paroxysm of atrial fibrillation together with ERW syndrome (Wolff-Parkinson-White syndrome, fraught with the development of ventricular fibrillation),
- Extremely severe tolerance of symptoms of paroxysmal atrial fibrillation,
- Intolerance to medication antiarrhythmic drugs,
- Frequent relapses of paroxysmal atrial fibrillation at short intervals,
- The expected higher efficiency of electric cardioversion than drug-induced in patients with a persistent form of atrial fibrillation (existing for more than a week, but capable of restoring the correct rhythm),
- Hybrid (simultaneous use of medications and electro-pulse therapy) with a persistent form of atrial fibrillation.
The main indication for defibrillation is ventricular, dangerous and life-threatening rhythm disturbances. These include persistent ventricular tachycardia, which is not amenable to drug treatment, especially accompanied by a decrease in blood pressure or the development of acute heart failure, as well as fibrillation (flickering) and ventricular flutter. In the latter case, defibrillation is the method of choice, since such rhythm disturbances are accompanied by clinical death.
Cardioversion, defibrillation: types, indications, conduct, result and consequences
Stroke is a fairly common complication of MA. For its prevention, it is necessary first of all to conduct an echocardiographic study to determine the function of the left ventricle, the condition of the valves, the presence of blood clots in the left atrium and its ear. Depending on the risk of developing thrombosis, patients are prescribed aspirin or oral anticoagulants (warfarin).
Aspirin is used at lower risk in patients younger than 60 years old, without organic heart damage and without risk factors, which include heart failure, low left ventricular ejection fraction and arterial hypertension. In all other cases, anticoagulants are prescribed. Continuous treatment with anticoagulants should be carried out under the supervision of a special indicator that determines the risk of thrombosis and bleeding, the so-called international normalized ratio (INR). Its target level should not be lower than 2,0. At the beginning of therapy, INR is determined weekly, with stabilization of the patient’s condition – monthly.
Of course, with such a powerful effect on the heart, complications can develop in some cases. The lighter ones disappear after a couple of hours, for example, changes on the ECG as an extrasystole, others last for several days, such as skin burns, and still others may be significant for human life.
Dangerous consequences include pulmonary edema, respiratory failure due to inadequate pain relief, pulmonary embolism, decreased blood pressure and ventricular fibrillation during cardioversion.
Diet for atrial fibrillation
What is helpful?
- take food in small portions, since a crowded and overstretched stomach irritates the vagus nerve, and it, in turn, slows down the pulse in the heart;
- the frequency of meals per day – at least four, and preferably 5-6;
- eat in a relaxed atmosphere, slowly, thoroughly chew food;
- increase the amount of fruits and vegetables eaten, they should be at least 50% of the total diet;
- consume foods rich in potassium and magnesium – cocoa, nuts, bran, oatmeal, brown rice, beans, baked potatoes, carrots, pumpkin, oranges, bananas, avocados, sprouted grains, etc .;
- drink a sufficient amount of clean water – 1,5-2 liters per day.
- overeating, especially at night;
- eat on the go, in a hurry, with strong emotional excitement;
- eat irritating foods and with high cholesterol – fatty meat, sour cream, lard, spicy seasonings, fried, alcohol, coffee, chocolate;
- very cold and very hot food.
Cardioversion for atrial fibrillation reviews
With non-rheumatic atrial fibrillation, the risk of normalizing thromboembolism is from 1 to 5% (an average of about 2%). Therefore, if atrial fibrillation continues for more than 2 days, you must stop trying to restore the rhythm and prescribe indirect anticoagulants (warfarin or phenyline) for 3 weeks in doses that support the international normalized ratio (INR) in the range from 2,0 to 3,0 (or maintain a prothrombin index of about 50%).
After 3 weeks, you can try to restore sinus rhythm using medication or electric cardioversion. With warfarin, the risk of thromboembolism during restoration of sinus rhythm is reduced to 0,5% or less. After cardioversion, the patient should continue taking indirect anticoagulants for another 1 month.
Thus, attempts to restore sinus rhythm can be made during the first 2 days of atrial fibrillation or after 3 weeks of taking anticoagulants. In any case: in the first 2 days it is necessary to administer heparin iv, and then treatment with anticoagulants depends on the effectiveness of cardioversion.
Using transesophageal echocardiography, cardioversion can be accelerated in patients with a flicker duration of more than 2 days. If during transesophageal echocardiography there are no signs of a thrombus in the left atrium, cardioversion is carried out after 1 -5 days of intravenous administration of heparin or subcutaneous administration of low molecular weight heparin.
In the tachysystolic form (when the average heart rate exceeds 100 beats / min), heart rate should first be reduced with drugs that block the AV node (convert to normosystolic form).
To reduce heart rate, the most effective drug is verapamil (isoptin, finoptin). Depending on the situation, verapamil is administered iv – 10 mg or administered orally – 80-120 mg or more under the control of heart rate achieved. The goal is to reduce heart rate to 60-80 per minute. In addition to verapamil, to reduce heart rate, you can use obzidan – 5 mg iv, then 80-120 mg orally or any other beta-blocker in doses necessary to control heart rate;
digoxin – 0,5-1,0 mg iv or orally, amiodarone – 150-450 mg iv, sotalol – 20 mg iv or 160 mg orally, magnesium sulfate – 2,5 g iv. In the presence of heart failure, the use of verapamil and beta-blockers is contraindicated, the drugs of choice are amiodarone and digoxin. It should be noted that digoxin is not suitable for rapid control of heart rate, because effective reduction in heart rate occurs only after 9 hours, even with iv administration.
In some cases, after the administration of these drugs, not only a decrease in heart rate occurs, but also a restoration of the sinus rhythm (especially after the introduction of cordarone). If the attack of atrial fibrillation has not stopped, after a decrease in heart rate, the question of the advisability of restoring the sinus rhythm is resolved.
Amiodarone – 300-450 mg iv (you can use a single oral administration of cordarone at a dose of 30 mg / kg, i.e. 12 tablets of 200 mg for a person weighing 75 kg)
Disopyramide – 150 mg iv or 300-450 mg orally;
Novocainamide – 1 g iv or 2 g orally (hereinafter – 0,5 g every 1 h – up to 4-6 g); Propafenone – 70 mg iv or 600 mg orally;
Quinidine – 0,4 g orally, then 0,2 g 1 hour before stopping (maximum dose – about 1,6 g);
It is very effective in / in the introduction of the domestic drug nibentan – 0-0625 mg / kg, if necessary repeatedly.
If quinidine, procainamide, disopyramide, or other class I drugs are prescribed in the tachysystolic form, without prior administration of the drugs,
blocking AV conduction, a flicker can transition into atrial flutter and a sharp acceleration of heart rate – up to 250 per minute or more (Fig.).
Currently, due to its high efficiency, good tolerance and ease of administration, the restoration of sinus rhythm in atrial fibrillation with the use of a single dose of amiodarone or class 1C drugs (propafenone or ethacyzine) is gaining popularity. The average recovery time of the sinus rhythm after taking amiodarone is 6 hours, after propafenone – 2 hours.
after etatsizin – 2,5 hours. With a normosystolic form, immediately use drugs to restore sinus rhythm. With repeated paroxysms of atrial fibrillation to restore sinus rhythm, patients can independently use the ingestion of drugs selected in the hospital: amiodarone, kinidin-durules, propafenone, or a combination of several drugs.
Features treatment of paroxysmal atrial fibrillation in patients with Wolff-Parkinson-White syndrome. With atrial fibrillation in patients with WPW syndrome, the use of verapamil and cardiac glycosides is contraindicated. Under the influence of these drugs, in some patients with WPW syndrome, a sharp acceleration of heart rate occurs, accompanied by severe hemodynamic disturbances; cases of ventricular fibrillation are known.
Therefore, for the relief of atrial fibrillation in patients with Wolff-Parkinson-White syndrome, amiodarone or procainamide are used. In doubtful cases (in the absence of confidence in the presence of WPW syndrome), it is most reliable to use amiodarone, because it is equally effective in all supraventricular and ventricular tachyarrhythmias.
To prevent recurrence of paroxysms of atrial fibrillation, antiarrhythmic drugs are prescribed. The most effective use of amiodarone. In some patients, prolonged preservation of the sinus rhythm or a decrease in the frequency of relapses is achieved while taking class I “A” drugs. I “C”, sotalol or beta blockers.
Radiofrequency ablation (isolation) of arrhythmogenic foci in the mouths of the pulmonary veins is effective in 70 – 80% of patients with paroxysmal atrial fibrillation and in 30 – 40% of patients with persistent atrial fibrillation, including and with refractory to drug treatment. Radiofrequency ablation is ineffective or ineffective with the vagal variant of paroxysmal atrial fibrillation. However, with the vagal variant of paroxysmal atrial fibrillation, ablation of the nerve endings of the parasympathetic nerves is used.
The main indication for the restoration of sinus rhythm with a constant form of atrial fibrillation is “the patient’s desire and the consent of the doctor.” Formally, indications for rhythm restoration are heart failure and / or thromboembolism. However, in practice, these conditions are often considered rather as contraindications, motivating this with the fact that in heart failure, as a rule, there is an increase in heart size, and this (especially an increase in the left atrium) is a sign of an increased likelihood of recurrence of atrial fibrillation, despite taking antiarrhythmic drugs
Electrical cardioversion is an electric discharge by direct current, synchronized with the activity of the heart, usually along the R-wave of a cardiogram. This ensures that electrical stimulation does not occur during the vulnerable stage of the cardiac cycle: 60-80 ms before and 20-30 ms after the top of the T-wave. Electrical cardioversion is used to treat all abnormal heart rhythms except ventricular fibrillation. The term “defibrillation” means asynchronous discharge, which is necessary for the treatment of ventricular fibrillation, but not AF.
In one study, 64 patients were randomly subjected to electrical cardioversion with initial energy at a monophasic waveform of 100, 200, or 360 J. The greater initial energy was significantly more effective than the lower (the percentage of immediate success was 14% at 100 J, 39% – 200, and 95% – at 360 J, respectively), leading to fewer discharges and less total energy when they started cardioversion with 360 J.
These data indicate that an initial discharge of 100 J is often too small. For electrical cardioversion with AF, an initial energy of 200 J or higher is recommended. There are devices that generate current with a two-phase waveform; they achieve cardioversion at lower energy levels than those using a monophasic waveform.
Thus, the success rate of external cardioversion ranges from 65% to 90%. The risk of electrical cardioversion is lower than the risk of medical cardioversion. Complications are quite rare, but they occur and it is necessary to notify the patient about them upon obtaining the patient’s consent to the procedure. The main complications of external cardioversion: systemic embolism, ventricular arrhythmias, sinus bradycardia, hypotension, pulmonary edema, ST segment elevation.
The restoration of sinus rhythm can reveal the existing syndrome of weakness of the sinus node or AV block, therefore, when performing cardioversion, one must be prepared to conduct temporary pacing. Electrical cardioversion is contraindicated in cases of intoxication with cardiac glycosides (it makes sense to delay at least 1 week, even in the case of the usual intake of cardiac glycosides, without intoxication), hypokalemia, acute infections and uncompensated circulatory failure.
Since electric cardioversion requires general anesthesia, any contraindication to general anesthesia is a contraindication to electric cardioversion. According to some observations, the efficiency of EIT reaches 94%. However, during and after EIT serious heart rhythm disturbances (ventricular asystole, sinus bradycardia, pacemaker migration, sinus arrhythmia), as well as other complications (thromboembolism, pulmonary edema, arterial hypotension) can develop.
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