| Fibrilación auricular: Métodos establecidos e innovadores para la evaluación y tratamiento |
Atrial fibrillation: established and innovative methods of evaluation and treatment.
Trappe HJ.
Medizinische Klinik II (Schwerpunkte Kardiologie und Angiologie), Ruhr-Universität Bochum. Hans-Joachim.Trappe@ruhr-uni-bochum.de
Dtsch Arztebl Int. 2012 Jan;109(1-2):1-7. Epub 2012 Jan 9.
Abstract
BACKGROUND: 5% to 8% of 70-year-olds and some 10% of persons over age 80 have atrial fibrillation (AF). METHODS: Selective literature review.RESULTS: New scoring schemes (CHA(2)DS(2)-VASc score, HAS-BLED score) have been introduced to enable more accurate estimation of the risk of stroke and hemorrhage in patients with AF. These scores are calculated on the basis of clinical data (left ventricular dysfunction, hypertension, age, diabetes, prior stroke, vascular diseases, sex, renal or hepatic dysfunction, bleeding, labile INR values, consumption of medications and alcohol) and are used to determine the potential indication for, and appropriate type of, anticoagulation in the individual AF patient. Hemodynamically unstable patients with rapid AF should undergo DC cardioversion at once. Patients with permanent AF should be given beta-blockers, calcium antagonists, or digitalis for rate control, with a target rate below 110/minute. A recently introduced drug, dronedarone, is used for rhythm control and has relatively few side effects. Patients with AF and impaired left ventricular function should be given amiodarone. Rhythm control has not been found to prolong life any more than rate control. Patients with a CHA(2)DS(2)-VASc score of 2 or above should be orally anticoagulated. Those with a score of 1 can be treated with aspirin (75 to 325 mg daily); those with a score of 0 do not need antithrombotic treatment. A HAS-BLED score of 3 or above is associated with a high risk of bleeding. Pulmonary vein isolation is an established method of treating symptomatic AF, with a success rate of 60% to 80%. Surgical procedures are possible in AF patients who need additional cardiac surgery. CONCLUSION: The treatment strategy for AF must be individualized on the basis of the patient's clinical manifestations. The mainstay of treatment is anticoagulation; the indication for anticoagulation depends on the patient's age, underlying disease, and left ventricular function.
http://www.aerzteblatt.de/pdf.asp?id=118211
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| Tratamiento farmacológico: control de la frecuencia cardíaca en pacientes con fibrilación auricular |
Carlos A. Restrepo J., MD.
Revista Colombiana de Cardiología Vol. 14 Suplemento 3, 2007
Cuando el médico se enfrenta a un paciente en ritmo de fibrilación auricular (FA), debe decidir entre dos estrategias de tratamiento: terminar la arritmia mediante su conversión a ritmo sinusal o tratar de mantener la frecuencia dentro de un rango razonable mientras que la fibrilación persiste. La primera se conoce como «control del ritmo» y la segunda como «control de la frecuencia».
http://www.scc.org.co/Portals/0/v14s3a10.pdf |
| Anestesia para cardioversión: estudio prospectivo randomizado comparando propofol y etomidato combinado con fentanilo |
Anaesthesia for cardioversion: a prospective randomised comparison of propofol and etomidate combined with fentanyl.
Kalogridaki M, Souvatzis X, Mavrakis HE, Kanoupakis EM, Panteli A, Kasotaki S, Vardas P, Askitopoulou H.
Department of Anaesthesiology, University of Crete, Heraklion, Greece.
Hellenic J Cardiol. 2011 Nov-Dec;52(6):483-8.
Abstract
INTRODUCTION: External electrical cardioversion is mostly performed solely under sedatives or hypnotics, although the procedure is painful. The aim of this prospective randomised study was to compare two anaesthetic protocols that included analgesia. METHODS: Patients with persistent atrial fibrillation were randomised to receive intravenously either fentanyl 50 μg and propofol 0.5 mg/kg (group P) or fentanyl 50 μg and etomidate 0.1 mg/kg (group E), while breathing spontaneously 100% oxygen. In the case of inadequate anaesthesia, repeated doses of 20 mg propofol (group P) or 4 mg etomidate (group E) were given as often as necessary until loss of eyelid reflex. Cardioversion was achieved with an extracardiac biphasic electrical shock ranging from 200 to 300 J, performed three times at most. RESULTS: Forty-six patients (25 in group P, 21 in group E), aged 64 ± 9 years, were enrolled in the study. There were no differences between the study groups concerning left ventricular ejection fraction, the dimension of the left atrium, the number of shocks needed or the number of unsuccessful cardioversions. Patients in group E had a shorter time from injection of the induction agents until loss of consciousness (49 vs. 118 s, p=0.003) and until the first shock was given (61 vs. 135 s, p=0.004). Systolic blood pressure decreased significantly (repeated measurements ANOVA with Bonferroni adjustment) in group P when the baseline value was compared to that after anaesthesia induction (mean decrease 15.2 mmHg, 95% CI 5.6-24.8 mmHg, p=0.001) and to the value after recovery (mean decrease 15.2 mmHg, 95% CI 4.8-25.7 mmHg, p=0.002). Manual ventilation was required in 7 and 9 patients in groups P and E, respectively (p=0.360). CONCLUSION: Both anaesthetic regimens provided excellent conditions for external electric cardioversion. In addition, etomidate in combination with fentanyl had a shorter induction time and ensured haemodynamic stability.
http://www.hellenicjcardiol.org/archive/full_text/2011/6/2011_6_483.pdf |
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