Treatment of Acute Atrial Fibrillation: Ventricular Rate Control and Restoration of Sinus Rhythm

2000 ◽  
Vol 7 (2) ◽  
pp. 85-95
Author(s):  
Ht Fung ◽  
Cw Kam
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Cardiac Output ◽  
General Population ◽  
Sinus Rhythm ◽  
Rate Control ◽  
Electrical Cardioversion ◽  
Ventricular Rate ◽  
The Past ◽  
Definite Risk

Atrial fibrillation (AF) is a familiar arrhythmia seen in the emergency department and the general population. In the past it was treated in the majority of cases by controlling the ventricular rate, whether the AF is acute or chronic. However, ventricular rate control alone does not address the underlying problem and the patients still remain in AF, cardiac output and symptoms have not been optimally corrected. There is definite risk of thromboembolism. Restoration of sinus rhythm is the only way of resuming the normal conduction physiology of the heart and correcting these problems This article provides a review of the two major principles of rhythm treatment of acute AF: rate control and restoration of sinus rhythm. Transthoracic electrical cardioversion is the mainstay of treatment in haemodynamically unstable AF, whereas in stable AF, there is a choice between rate control and restoration of sinus rhythm, or they can be carried out in conjunction with each other.

scholarly journals Use of rate control medication before cardioversion of recent-onset atrial fibrillation or flutter in the emergency department is associated with reduced success rates

CJEM ◽  
2012 ◽  
Vol 14 (03) ◽  
pp. 169-177 ◽  
Author(s):  
Gabriel E. Blecher ◽  
Ian G. Stiell ◽  
Brian H. Rowe ◽  
Eddy Lang ◽  
Robert J. Brison ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Rate Control ◽  
Rhythm Control ◽  
Electrical Cardioversion ◽  
Ventricular Rate ◽  
Recent Onset ◽  
Factors Associated ◽  
Onset Atrial Fibrillation ◽  
Control Medication

ABSTRACTObjective:It is believed that when patients present to the emergency department (ED) with recent-onset atrial fibrillation or flutter (RAFF), controlling the ventricular rate before cardioversion improves the success rate. We evaluated the influence of rate control medication and other variables on the success of cardioversion.Methods:This secondary analysis of a medical records review comprised 1,068 patients with RAFF who presented to eight Canadian EDs over 12 months. Univariate analysis was performed to find associations between predictors of conversion to sinus rhythm including use of rate control, rhythm control, and other variables. Predictive variables were incorporated into the multivariate model to calculate adjusted odds ratios (ORs) associated with successful cardioversion.Results:A total of 634 patients underwent attempted cardioversion: 428 electrical, 354 chemical, and 148 both. Adjusted ORs for factors associated with successful electrical cardioversion were use of rate control medication, 0.39 (95% confidence interval [CI] 0.21-0.74); rhythm control medication, 0.28 (95% CI 0.15-0.53); and CHADS2score > 0, 0.43 (95% CI 0.15-0.83). ORs for factors associated with successful chemical cardioversion were use of rate control medication, 1.29 (95% CI 0.82-2.03); female sex, 2.37 (95% CI 1.50-3.72); and use of procainamide, 2.32 (95% CI 1.43-3.74).Conclusion:We demonstrated reduced successful electrical cardioversion of RAFF when patients were pretreated with either rate or rhythm control medication. Although rate control medication was not associated with increased success of chemical cardioversion, use of procainamide was. Slowing the ventricular rate prior to cardioversion should be avoided.

scholarly journals “Wait and See” Approach to the Emergency Department Cardioversion of Acute Atrial Fibrillation

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Brian Doyle ◽  
Mark Reeves
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Sinus Rhythm ◽  
Normal Sinus Rhythm ◽  
Routine Care ◽  
Spontaneous Resolution ◽  
Electrical Cardioversion ◽  
Normal Sinus ◽  
Degree Of Satisfaction ◽  
Wait And See

Objective. Acute atrial fibrillation often spontaneously resolves. This study aimed to investigate the outcomes and satisfaction of an evidence-based ED protocol employing a “wait and see” approach.Methods. A prospective observational cohort study of adult patients presenting to the Emergency Department with stable acute atrial fibrillation was performed. Patients were excluded if they were considered to be unstable, need hospitalization, or poor candidates for ED procedural sedation. Routine care was provided on the index visit, and suitable candidates were discharged and asked to return to the ED the following day for possible electrical cardioversion. Outcome measures included spontaneous reversion to sinus rhythm, success of cardioversion, length of stay, adverse event and return visits for AF within 30 days, and patient satisfaction.Results. Thirty five patient encounters were analysed over a 21-month period. Twenty two of the 35 patients (63%) had spontaneous resolution of atrial fibrillation upon presentation for potential cardioversion. All of the remaining patients underwent successful cardioversion to normal sinus rhythm without significant adverse events recorded. No patients required hospitalization. Three patients (9%) returned to the ED within 30 days for recurrence of atrial fibrillation. All patients were reported to be “very satisfied” with this approach.Conclusion. A “wait and see” approach to the ED electrical cardioversion of atrial fibrillation showed that almost two-thirds of patients had spontaneous resolution without requiring cardioversion or observation in the ED or hospital. All patients were successfully reverted to normal sinus rhythm and had a high degree of satisfaction.

scholarly journals Current Drug Treatment Strategies for Atrial Fibrillation and TASK-1 Inhibition as an Emerging Novel Therapy Option

2021 ◽  
Vol 12 ◽  
Author(s):  
Manuel Kraft ◽  
Antonius Büscher ◽  
Felix Wiedmann ◽  
Yannick L’hoste ◽  
Walter E. Haefeli ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Rate Control ◽  
Antiarrhythmic Drugs ◽  
Heart Diseases ◽  
Pulmonary Veins ◽  
Treatment Strategies ◽  
Rhythm Control ◽  
Electrical Cardioversion ◽  
Adequate Treatment

Atrial fibrillation (AF) is the most common sustained arrhythmia with a prevalence of up to 4% and an upwards trend due to demographic changes. It is associated with an increase in mortality and stroke incidences. While stroke risk can be significantly reduced through anticoagulant therapy, adequate treatment of other AF related symptoms remains an unmet medical need in many cases. Two main treatment strategies are available: rate control that modulates ventricular heart rate and prevents tachymyopathy as well as rhythm control that aims to restore and sustain sinus rhythm. Rate control can be achieved through drugs or ablation of the atrioventricular node, rendering the patient pacemaker-dependent. For rhythm control electrical cardioversion and pharmacological cardioversion can be used. While electrical cardioversion requires fasting and sedation of the patient, antiarrhythmic drugs have other limitations. Most antiarrhythmic drugs carry a risk for pro-arrhythmic effects and are contraindicated in patients with structural heart diseases. Furthermore, catheter ablation of pulmonary veins can be performed with its risk of intraprocedural complications and varying success. In recent years TASK-1 has been introduced as a new target for AF therapy. Upregulation of TASK-1 in AF patients contributes to prolongation of the action potential duration. In a porcine model of AF, TASK-1 inhibition by gene therapy or pharmacological compounds induced cardioversion to sinus rhythm. The DOxapram Conversion TO Sinus rhythm (DOCTOS)-Trial will reveal whether doxapram, a potent TASK-1 inhibitor, can be used for acute cardioversion of persistent and paroxysmal AF in patients, potentially leading to a new treatment option for AF.

γ-Adrenergic Blockade Accelerates Conversion of Postoperative Supraventricular Tachyarrhythmias 

1998 ◽  
Vol 89 (5) ◽  
pp. 1052-1059 ◽  
Author(s):  
Jeffrey R. Balser ◽  
Elizabeth A. Martinez ◽  
Bradford D. Winters ◽  
Philip W. Perdue ◽  
Ann Wray Clarke ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Sinus Rhythm ◽  
Rate Control ◽  
Noncardiac Surgery ◽  
Ventricular Rate ◽  
Adrenergic Blockade ◽  
Supraventricular Tachyarrhythmia ◽  
To Receive

Background Postoperative supraventricular tachyarrhythmia is a common complication of surgery. Because chemical cardioversion is often ineffective, ventricular rate control remains a principal goal of therapy. The authors hypothesized that patients with supraventricular tachyarrhythmia after major noncardiac surgery who receive intravenous beta-adrenergic blockade for ventricular rate control would experience conversion to sinus rhythm at a rate that differs from those receiving intravenous calcium channel blockade. Methods The rate of conversion to sinus rhythm at 2 and 12 h after treatment was examined in 64 cases of postoperative supraventricular tachyarrhythmia. After adenosine administration, patients who remained in supraventricular tachyarrhythmia were prospectively randomized to receive either intravenous diltiazem or intravenous esmolol for ventricular rate control (unblinded). Loading and infusion rates were adjusted to achieve equivalent degrees of ventricular rate control. Results Patients were similar with regard to age and Apache III score. Most patients in both groups had atrial fibrillation (esmolol, 79%; diltiazem, 81%), and none experienced stable conversion with adenosine. Patients randomized to receive esmolol experienced a 59% rate of conversion to sinus rhythm within 2 h of treatment, compared with only 33% for patients randomized to receive diltiazem (intention to treat, P = 0.049; odds ratio, 2.9; 95% confidence interval, 1.046 to 7.8). After 12 h of therapy, the number of patients converting to sinus rhythm increased in both groups (esmolol, 85%; diltiazem, 62%), and the rates of conversion no longer differed significantly. Ventricular rates when supraventricular tachyarrhythmia began and after 2 and 12 h of rate control therapy were similar in the two treatment groups. The in-hospital mortality rate and length of stay in the intensive care unit were not significantly influenced by treatment group. Conclusions Among adenosine-resistant patients in the intensive care unit with atrial fibrillation after noncardiac surgery, intravenous esmolol produced a more rapid (2-h) conversion to sinus rhythm than did intravenous diltiazem.

scholarly journals A Case of Refractory Atrial Fibrillation Treated with Amiodarone

2013 ◽  
Vol 21 (2) ◽  
pp. 108-110
Author(s):  
Md Zahid Alam ◽  
Pranob Karmaker ◽  
Rowsan Ara ◽  
Monzoor Quader ◽  
MM Zahurul Alam Khan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Direct Current ◽  
Rate Control ◽  
Maintenance Dose ◽  
Ventricular Rate

We report a case of atrial fibrillation (AF) of unknown duration with fast ventricular rate which was refractory to intravenous (i.v.) digoxin, verapamil and DC (direct current) shock regarding rate control. Amiodarone was given in bolus & then in maintenance dose which ultimately controlled the rate and finally converted into sinus rhythm. DOI: http://dx.doi.org/10.3329/bjmed.v21i2.13622 Bangladesh J Medicine 2010; 21: 108-110

scholarly journals Acutely Onset Amiodarone-Induced Angioedema in a Patient with New Atrial Fibrillation

2014 ◽  
Vol 2014 ◽  
pp. 1-2 ◽  
Author(s):  
Hossein Vakili ◽  
Isa Khaheshi ◽  
Mehdi Memaryan ◽  
Habib Haybar ◽  
Shooka Esmaeeli
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Coronary Artery ◽  
Sinus Rhythm ◽  
Rate Control ◽  
Drug Eluting Stent ◽  
Rare Side Effect ◽  
Intravenous Amiodarone ◽  
History Of ◽  
Drug Eluting

A 50-year-old man was admitted to our emergency department due to new episode of palpitation. He had history of angioplasty of right coronary artery (RCA) with drug eluting stent 2 years ago. His electrocardiogram revealed atrial fibrillation (AF). Intravenous amiodarone 150 mg during 10 minutes and then 1 mg/min infusion were started to achieve rate control and pharmacologic conversion to sinus rhythm. After 60 minutes of starting amiodarone infusion, he developed swelling of the skin around his mouth and eyes, and also mucosa of the mouth, eyes and tongue. To conclude, angioedema should be considered a rare side effect of amiodarone which is used broadly in cardiovascular field.

scholarly journals How to Manage Atrial Fibrillation in the Emergency Department: a Critical Appraisal

2020 ◽  
Vol 33 (1) ◽  
pp. 55-66
Author(s):  
Rafael Thiesen Magliari ◽  
José Nunes de Alencar Neto
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Heart Rate ◽  
Sinus Rhythm ◽  
Emergency Room ◽  
Emergency Management ◽  
Rate Control ◽  
Critical Appraisal ◽  
Heart Rate Control ◽  
The Subject

Atrial fibrillation is the most common cardiac arrhythmia in emergency departments. There is growing evidence that certain patients with acute atrial fibrillation can be safely managed in the emergency room without the need for hospitalization, minimizing costs and reducing unnecessary exposures. This review addresses the emergency management of atrial fibrillation based on the latest updates on the subject with a focus on the assessment and prevention of thromboembolic phenomena, control of frequency x control of rhythm and strategies for cardioversion and restoration of sinus rhythm or for heart rate control.

Sign in / Sign up

Export Citation Format

Share Document