BACKGROUND
Approximately 10% to 30% of patients with atrial flibrillation (AF) do not present structural heart disease or have a comorbidity such as hypertension. Atrial fibrillation is the most frequent arrhythmia in daily practice that occurs under diverse situations and its treatment should be based on the different scenarios of presentation. Severe population-based studies have found that AF is associated with greater morbidity and mortality and worse quality of life. It is the leading cause of arrhythmia-related hospitalizations with an important impact on medical costs.
Radiofrequency catheter ablation steadily progresses as an option therapy to cure atrial fibrillation. The indications of catheter ablation are increasing due to a greater understanding of the physiopathological mechanisms, technological improvements and better outcomes. The Spanish registry reported that 1 out of 10 catheter ablations were indicated for AF. In the USA, AF is the most frequent condition undergoing catheter ablation in referral centers. How have we reached this point?
THE PROBLEM OF ANTIARRHYTHMIC TREATMENT
Drug therapy has proved to be ineffective to maintain sinus rhythm in patients with AF, with recurrence rates between 40% and 80%. Class I antiarrhythmic drugs are ideal for patients without structural heart disease or with mild conditions due to a lower proarrhythmic risk and better tolerance; yet, the efficacy if these agents is < 40%. In the AFFIRM and RACE studies, the group of patients without structural heart disease was small, and only 30% to 60% were still in sinus rhythm during follow-up. A meta-analysis comparing the efficacy of antiarrhythmic agents to maintain sinus rhythm showed that the proportion of patients in sinus r...
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...apy for some patients. Circulation 2005;112:1214-31.
15. Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, et al. Prevalence and causes of fatal Outcome in catheter ablation of atrial fibrillation. J Am Coll Cardiol 2009;53:1798-803.
16. Garcia-Bolao I, Diaz-Infante E, Gallego AM; Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias. Spanish Catheter Ablation Registry. Seventh official report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2007). Rev Esp Cardiol 2008;61:1287-97.
17. Hindricks G. The Multicentre European Radiofrequency Survey (MERFS): complications of radiofrequency catheter ablation of arrhythmias. The Multicentre European Radiofrequency Survey (MERFS) investigators of the Working Group on Arrhythmias of the European Society of Cardiology. Eur Heart J 1993;14:1644-53.
Transcatheter aortic valve replacement or TAVR is the latest technology used principally for the treatment of aortic stenosis, a condition in which one of the major valves of the heart, the aortic valve, becomes tight and stiff, usually as a result of aging (3). Since many patients who need aortic valve replacement for aortic stenosis are too sick to undergo major valve replacement surgery, they are unable to get the treatment they need. With the transcatheter aortic valve, this issue is bypassed because this valve can be implanted in the heart by accessing the patient’s heart through an artery in the groin. The valve can be inserted through a wire that can be pushed to the heart and the old valve is simply pushed to the side when the new valve is implanted. This technology has been in use in the US with Edwards’ Sapiens valve since 2011 and has saved the lives of many patients with aortic stenosis (4). Medtronic’s CoreValve uses similar technology and has won patent fights in Europe and has been in use internationally. However, within U.S., Medtronic has not been...
Racemic albuterol is a β2- adrenergic agonist that is a 50:50 mixture of two isomers, (R) albuterol and (S) albuterol. These two isomers are mirror images of each other, and rotate light in opposite directions. (R) Albuterol is an active isomer and in this combination acts an active bronchodilator. The other half of the mixture, (S) albuterol, does not actually possess any bronchodilator activity and was until recently considered an “inactive” distomer or physiologically inert. The “R” stands for rectus or right, while the “S” is for sinister or left. Racemic albuterol was synthesized for maximal airway smooth muscle dilation while minimizing the α- and β1-receptor mediated effects on the cardiovascular system.
In this lab, I took two recordings of my heart using an electrocardiogram. An electrocardiogram, EKG pg. 628 Y and pg. 688 D, is a recording of the heart's electrical impulses, action potentials, going through the heart. The different phases of the EKG are referred to as waves; the P wave, QRS Complex, and the T wave. These waves each signify the different things that are occurring in the heart. For example, the P wave occurs when the sinoatrial (SA) node, aka the pacemaker, fires an action potential. This causes the atria, which is currently full of blood, to depolarize and to contract, aka atrial systole. The signal travels from the SA node to the atrioventricular (AV) node during the P-Q segment of the EKG. The AV node purposefully delays
It occurs because of repetitive electrical activity. This can occur in a patient with early or late heart failure, because there is damage to the heart tissue and the heart beats faster to try to supply the body with blood. Recommended treatment is elective cardioversion. Drugs used include an antidysrhythmic such as Mexitil or Sotalol (Ignatavicius &Workman, p. 728-729).
..., Welsh R, Feindel C, Lichtenstein S. Transcatheter aortic valve implantation: a Canadian Cardiovascular Society position statement. Can J Cardiol. 2012;28:520-8.
Atrial fibrillation (AF) is a cardiac arrhythmia. It is the most common arrhythmia and it has implications for patients and anaesthetists alike. The anaesthetist must take into consideration the physiological and pharmacological implications of this common arrhythmia.
The American Heart Association gives sufficient evidence for the need of change by acknowledging that sudden cardiac arrest is a leading cause of death (2012). These fatalities affect both adult and child victims. Statistics also show that 70% of people feel helpless during a cardia...
to other locations in the hospital could be disruptive to patient flow through the cardiology department's echo lab. Other areas in the hospital in which echocardiography equipment might be used...
...le the patient is sleeping. Other treatments similar to electrical cardioversion are used to treat AF. The treatment needed again depends on the severity and what a medical practitioner feels can most appropriately fits the situation (National Heart, Lung, and Blood Institute, 2014).
If there are no blood clots, then electrical mapping will be performed to see where the false signals are coming from. Small wires are then stuck in blood vessels and thread to the heart. Once to the heart, the wires will target the area where the false signals are being sent and diminish it. (Treatment 3) If the AV node is the area sending out false signals, a pacemaker must be put in the AV node’s place (3). A pacemaker is an electrical device that sends out electrical signals telling the heart to beat (5). A more serious procedure done to treat atrial fibrillation is called the maze procedure.
The defibrillator monitors the heart and automatically gives electric shocks before Arrhythmia causes permanent damage. If the person does not have a defibrillator a strong electric shock will be given. The cause of Tachycardis is by something not functioning properly in the atria. They are sometimes stimulated by anxiety. Too much caffeine or alcohol and certain drugs can also be the cause.
A permanent pacemaker implantation is a highly recommended treatment, An estimated 40% of patients with AV block undergo cardiac pacing because of the condition syncopal, in which pacing also appears to very successful in preventing (“fainting” insufficient blood/oxygen pumping) recurrences in patients with AV blocks. This attributes to much of the symptoms like dizziness and so on. This is especially important when talking about long-term care, because once it is adjusted for optimum efficiency you can continue to be physical, walking, hiking, etc.
Yang, J., Teehan, D., Farioli, A., Baur, D., Smith, D., & Kales, S. N. (2013). Sudden Cardiac Death Among Firefighters £45 Years of Age in the United States. American Journal of Cardiology, 1962-1967.
Cardiac dysrhythmias come in different degrees of severity. There are heart conditions that you are able to live with and manage on a daily basis and those that require immediate attention. Atrial Fibrillation is one of the more frequently seen types of dysrhythmias (NIH, 2011). The best way to diagnosis a heart condition is by reading a cardiac strip (Ignatavicius &Workman, 2013). Cardiac strips play an chief part in the nursing world allowing the nurse and other trained medical professionals to interpret what the heart is doing. In a normal strip, one can clearly identify a P wave before every QRS complex, which is then followed by a T wave; in Atrial Fibrillation, the Sinoatrial node fires irregularly causing there to be no clear P wave and an irregular QRS complex (Ignatavicius & Workman, 2013). Basically, it means that the atria, the upper chambers of the heart, are contracting too quickly and no clear P wave is identified because of this ‘fibrillation’ (Ignatavicius & Workman, 2013).
The heart beats when electrical signals move through it. Ventricular fibrillation is a condition in which the heart's electrical activity becomes disordered. When this happens, the heart's lower (pumping) chambers contract in a rapid, unsynchronized way. (The ventricles "flutter" rather than beat.) The heart pumps little or no blood therefore the probability of death is high.