Atrial fibrillation treated-_3334

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					Atrial fibrillation treated?

I suffer from atrial fibrillation with amiodarone 5 years eat, eat to maintain
a pill and amiodarone on March 24 this year, a relapse. Hospital by a medical
examination that amiodarone can not eat the (cardiac arrest Jump intermittent
3.2 seconds), I installed some on the mobilization of the pacemaker, I did not
install. There is now more than two months, June 5 Holter examination the
doctor said to do no major problem is that atrial fibrillation, but not fear
of heart medication long pause will appear, who knows how to do ah? please
tell me thank you

atrial fibrillation is a common heart rhythm disorder, clinical studies in
recent years has become a hot spot. but also further aware of atrial
fibrillation is thromboembolic event one of the main reason reason, such cases
75% of the patients with cerebral vascular accident. Although atrial
fibrillation are often associated with organic heart disease, but
approximately 30% of the patients had no organic disease. symptoms in patients
with atrial fibrillation, hemodynamic damage, disability, shortened life
expectancy and medical cost increases.

thromboembolism prevention of atrial fibrillation

prevention of thromboembolism is the treatment of atrial fibrillation One of
the important end point, the risk of thrombosis and heart disease related to
the nature and potential. Framingham study of non-rheumatic atrial
fibrillation thrombosis risk of heart disease is 5.6 times the control group,
while the risk of rheumatic heart disease and atrial fibrillation, compared
with 17.6 times the thrombosis. In recent years, primary prevention of
thromboembolic events in atrial fibrillation occurred aspects of large-scale
trials showed warfarin to cerebral vascular accident rate from 12% to 4%. When
INR> 4 时 warfarin may increase the risk of bleeding, INR 2 -3 anticoagulation
when effective, does not increase the risk of bleeding, research also shows
that warfarin may reduce mortality. have been several randomized trials
comparing the effectiveness of warfarin anticoagulation with aspirin. small
dose (75mg / day) and aspirin better than placebo, stroke prevention in atrial
fibrillation trials, higher doses of aspirin (325mg / day), then received some
benefit.

cardioversion of atrial fibrillation

emerging pharmaceutical cardioversion of atrial fibrillation, duration if less
than 48 hours, several anti-arrhythmic drugs can be used for cardioversion.
Since atrial fibrillation is not fatal arrhythmia, so no matter what kind of
treatment must be safe , no side effects. 1. control study of digoxin is not
better than placebo, it has always been thought to contribute to the transfer
law of atrial fibrillation and more through its positive inotropic effect of
improving the hemodynamic effectiveness of indirect play cardioversion , not a
direct electrophysiological effect. 2. open and placebo-controlled study
showed that intravenous flecainide, propafenone can make 81% of patients
converted to sinus rhythm of atrial fibrillation. has proved to oral
flecainide and propafenone for acute cardioversion of atrial fibrillation and
long-term treatment. In placebo-controlled study of single dose oral loading
dose propafenone 600mg, 3 hours after the 50% transfer rule, 70-80% after 8
hours sinus rhythm. Ic drugs should not be used for heart failure , low
ejection fraction, and conductive disorders. 3. This study showed that 600mg a
day can make 20% of oral amiodarone cardioversion failed or Guadai had several
medications used for patients transferred into the complex music, no obvious
side effects . Intravenous amiodarone for the treatment of acute atrial
fibrillation, it was reported effective rate of 25-83%, commonly used in acute
myocardial infarction or Ic drugs in patients with anti-indications. Ibutilide
is a class III antiarrhythmic drug, used for static Note termination of atrial
fibrillation, has been used in the United States. Dofetilide and Ibutilide is
a unified class of drugs to terminate AF have significant results, for heart
failure, decreased contraction efficiency, high-risk patients after myocardial
infarction, does not affect mortality. Applications III class cutting-edge
anti-arrhythmic drugs that cause potentially dangerous rotating ventricular
tachycardia 4.. Cardiac atrial fibrillation after suture removal more common,
but self-limiting bias. calcium antagonists and β receptor blockers have been
used after surgery AF treatment, its effectiveness needs to be further
confirmed. If atrial fibrillation secondary to hyperthyroidism, thyroid effect
transfer law should be back to normal in the backward line.

electrical cardioversion to sinus rhythm when AF switch drugs or persistent
failure of hair to hemodynamic disorders associated with, the timely use of
electricity transfer. transthoracic external direct current cardioversion of
chronic atrial fibrillation transfer law method, one or sometimes several
times before music into shock. technology, the value of real significance when
attention Conceiving the internal electrode size , electrode position,
transthoracic impedance, the output waveform and the amount of energy storage
(50-400J). advocates can begin to volume of 200J, 75% or more patients with
atrial fibrillation can turn music into a complex, if not music as
cardioversion 200J , you need to use more energy volume (360J). discharge
needs with the appropriate R wave synchronization, it can avoid the electric
shock induced ventricular fibrillation.

of atrial fibrillation lasted 48 hours or more patients, advocates In the 3
weeks before cardioversion and 1 month after cardioversion with oral
anticoagulant therapy.

ventricular rate control of atrial fibrillation

drug treatment 1. digitalis drugs: because of atrioventricular delay, growth
should slow down on ventricular rate. but also shorten the atrial refractory
period so that faster heart rate, increased heart rate to slow down the
concealed conduction. Compared with other drugs, digitalis has a unique
strength is able to improve cardiac efficiency. 2. β-blockers: an extension
of atrioventricular nodal effective refractory period and conduction time.
intravenous administration can quickly slow down the heart rate, but due to
negative inotropic effect obviously does not apply to heart failure and the
effect of structural heart disease patients. oral medication can slow down the
heart rate, is able to significantly improve exercise tolerance in patients,
even in patients with heart failure effects, oral agents can also improve the
quality of life of patients. 3. calcium antagonists: verapamil and diltiazem
tables can extend AV node refractory period and conduction time. intravenous
administration to quickly slowed heart rate, a certain degree of negative
inotropic effect but may be vasodilation the role of each eliminated. other
drugs such as sotalol and amiodarone can be used to control ventricular rate
in chronic atrial fibrillation. sotalol does not in itself an extension of
atrioventricular node refractory period, the ventricular rate slowing effect
with the drug effect on β blockers. amiodarone can control atrial
fibrillation at rest and exercise ventricular rate, the mechanism is to extend
the refractory period of atrioventricular conduction system, limited due to
side effects, not long-term administration.

radiofrequency ablation treatment 1. radiofrequency ablation of
atrioventricular block. 2. atrioventricular node in modified.

the use of special devices

treatment and prevention of atrial pacing ① Single-site atrial pacing atrial
fibrillation: the location of single site atrial pacing in the right atrial
appendage, high right atrium, right atrial septum, sector and, near the
coronary sinus openings and other parts. ② multi-site atrial pacing: is
divided into Double room synchronization or multi-site right atrial pacing two.
The former right atrial pacing in the original, based on the specific coronary
sinus leads were placed in the coronary sinus left and right atrial pacing.
which the other electrode placed in the right atrial septum, sector X or
coronary sinus opening at the bottom. high right atrial pacing can reduce the
recurrence rate of atrial fibrillation to 9-16%, while the control group, AF
recurrence rate was 32-69 VVI pacing %. multi-site right atrial pacing, there
can be 80% of patients reported maintenance of sinus rhythm. atrial pacing
therapy is currently considered compensatory treatment is drug therapy with
auxiliary means, not an alternative drug treatment methods.

implantable atrial defibrillator for atrial fibrillation (IAD) with an arc
with a defibrillation defibrillation electrodes fixed in a proactive manner
atrium, another arc with defibrillation defibrillation electrodes do not
active mode fixed in the coronary sinus. atrial sensing and defibrillation in
the right atrium and between coronary sinus electrode. a standard bipolar
electrode wire used in heart ventricular electrogram R wave synchronization
and right ventricular pacing. IAD to record and detect atrial electrogram and
ECG, to detect R wave synchronized atrial fibrillation and perception.
defibrillator implanted with wires connected to the chest area, the same
method and ordinary pacemaker. It is reported recovery room transfer IAD
flutter into the music reached 93.4%, the average require 1-2 times per atrial
fibrillation shocks, power is about 4.6J. because cost to ask questions before
the title is still a small domestic applications.

radiofrequency ablation treatment of atrial fibrillation

atrioventricular block radiofrequency ablation technology for the bulk of the
atrioventricular node catheter to the location records to the His bundle
potential, the discharge amount of 30-50W can be or 60-70 ℃, continuous 60s,
most of the patients will be able to 1 atrioventricular block, and then
install the DDD pacemaker. whether it is persistent and paroxysmal atrial
fibrillation, is not good if the drug control, radio frequency ablation of
atrioventricular conduction system is blocked benefits to patients can be: (1)
RF ablation of acute and chronic hemodynamic status were significantly
improved. ejection fraction increased from 27% to 45%, onset of heart failure
patients the opportunity to follow up more than 50% reduction; ( 2) the
symptoms may disappear in patients with palpitations; (3) ventricular rate
control is no longer needed drugs; (4) to improve the quality of life of
patients.

atrioventricular node atrioventricular node in modified by radiofrequency
ablation in modified method of changing the transmission characteristics of
atrioventricular node, the ventricular rate in atrial fibrillation but not too
fast not to cause complete atrioventricular block. ablation of specific ways
the equivalent of dual atrioventricular node pathways in the slow pathway.
ablation endpoint was atrial pacing Venturi points to 120 early / min.

radiofrequency catheter ablation of paroxysmal atrial fibrillation presented
in 1994, doctors in France Haissaguerre the concept of focal atrial
fibrillation statement. There is no strict Definition, generally refers to
atrial fibrillation from the atrium occurred in one or more fixed as early as
the trigger or drive housing. This atrial premature beats 70% of left superior
pulmonary vein and right superior pulmonary vein. followed by the left
inferior pulmonary vein, right lower pulmonary vein, right atrial crista
terminalis, right atrial septal and near the mouth of the coronary sinus. in
the pulmonary vein side to the high standard within the pulmonary vein
potentials tip (PVP), sinus rhythm with low blunt the atrial potential (aP) in
the former, PVP in the post; room as early as when the PVP in the former, aP
in the post. the bulk of catheter ablation to mapping to the surface P wave
Zuiwei earlier than the PVP potential, located Wendu 60 ℃ for ablation. At
present the mechanisms and ablation of atrial fibrillation is inconclusive,
ablation of the music into the rate was only 30% and the relapse higher rates
and complications, is only at the exploratory stage. November 2000
Haissaguerre latest views again, using PV circular mapping electrode mapping
the earliest pulmonary vein opening of the translocation site of the ablation,
thereby blocking the atrium and pathway between the pulmonary veins, so that
suture removal was significantly shorter ablation of music into a single rate
of 56% (39/70), the total rate of music into 72% (51/70). Besides the birth of
ultrasound balloon catheter is easy to inter-atrial and pulmonary vein
conduction block. views updated and improved apparatus for the treatment of
atrial fibrillation ablation demonstrated new hope.

atrial maze Development and Evaluation of suture removalWith the
electrophysiology of atrial fibrillation

depth study of atrial fibrillation maze cut suture suture removal from the
standard development of the maze was a maze of radioactive incision suture
removal, suture removal of left or right side of the maze.

1 , suture removal maze Ⅲ

1991 年 Cox the animal experiments and clinical electrophysiology of the
invention when the atrial fibrillation there are several large reentrant loop
around the terminal crest, vena cava and pulmonary vein mouth, and its reentry
path uncertain variable, instantaneous change, there is no way by the path of
electrophysiological mapping guided resection suture, thus creating multiple
incisions can be blocked by atrial reentry and to all of sinus impulses to
simultaneously excited by the specific path atrium to the atrioventricular
node Migong removed Fenghe. Migong Ⅲ suture is removed from the Mi Gong I,
II-type resection Fenghe improvements comes, cut incision suture removal, to
avoid the sinus node artery damage, and from large to small isolated left
atrial size, reach more good heart rate response and atrial chronotropic
effect of the recovery.

Conceiving the standard maze labyrinth type Ⅲ suture removal suture removal
most cases, the longest follow-up and treatment effectiveness of the best, is
to carry out the first atrial fibrillation, the most effective surgical
treatment, led to the development of new surgical treatment of atrial
fibrillation, a landmark achievement. 1999 Cox maze of 306 cases reported in
259 cases of suture removal (85%) of the maze type Ⅲ suture removal, of which
37.8% of the line valve replacement or coronary artery bypass earlier suture
removal, suture removal mortality rate of 3.3%. The average follow-up of 3.7
years, 98.2% of patients with atrial fibrillation be cured, only 1.8% required
anti-arrhythmic drugs. magazine reported maze with a group of mitral valve
replacement period of 8 years follow-up suture removal, is the longest
reported follow-up period, also showed a 100% cure rate of atrial fibrillation.
2000-2003 McMathy, Schafl, Muller, Lee reported 100 cases, respectively, , 221
cases, 76 cases and 129 cases of suture removal Ⅲ maze, there are similar
results, preoperative and postoperative incidence of sick sinus syndrome, 6% -
30%.

2, suture removal of the left labyrinth

1995 年 Harada and Sueda were merged in chronic atrial fibrillation patients
with pure mitral valve surgery using the two atrial epicardial
electrophysiological mapping, invented the left atrial appendage and / or left
pulmonary vein duplication of the mouth there are rules excited, so that the
left atrium is the source of atrial fibrillation such patients, the left side
of the maze presented and the purposes of removal of sutures. The removal of
suture removal only for labyrinth type Ⅲ part of the left atrial suture. left
open the application maze procedure epicardial electrophysiological mapping
the maze under the guidance of precedent for removal of sutures, all catheter
ablation for the development of practice laid the foundation, but its
effectiveness as a maze type Ⅲ suture removal. In 2001 Imai reported 32 cases
of resection of the left side of the maze and mitral valve closure,
intraoperative AF disappeared after 3 years was 74%, right atrial recovery
efficiency was 100%, left atrium was 60%.

3, right side of the maze cut suture

1996 年 Rodefeld and Gaudhi confirmed by animal experiments can be induced by
suture Crista reentry atrial flutter and fibrillation. then on Theodoro and
Danielson Ebstein secundum atrial septal defect and atrial fibrillation who
merged the purposes of heart malformations heart repair suture removal plus
maze right, right part of the heart increased while those for resection of the
right atrium. Theodoro and the 1998 report of 15 cases of Danielson Ebstein
heart malformation, 2 cases of first nature, and 1 case of tricuspid
regurgitation secondary to atrial septal defect atrial flutter and atrial
fibrillation merge are implemented resection of the right side of the maze and
the three suture removal of suture repair heart defects, 16 patients with
sinus rhythm at discharge, 2 cases of borderline heart rate, heart effects are
I-level.

1999 年 Nitta under the left atrial activation sequence and were designed to
place radioactive coronary maze incision suture removal, hoping to reach than
the labyrinth type Ⅲ atrial activation sequence is more consistent and
maintain the effectiveness of the left atrium. resection suture method such as
maze III, right atrial incision and suture, but not the removal of right
atrial appendage, as has always been on the atrial septum incision. no part of
the left atrium around the pulmonary vein isolation for the left atrium, and
in each pulmonary vein around freezing, excision of left atrial appendage,
lungs veins at the top to make a transverse incision into the right atrial
appendage incision, under both lungs vein below to make a transverse incision
at the mitral annulus before the diplomatic community.

radiation maze procedure carried out in only a few units, followed a short
time, long-term results to be not Yacha, but the maze of radioactive incision
suture removal without excision of the right atrial appendage, left atrium
without quarantine, keeping left and right atrium after the maze III efficacy
than the good type suture removal. 1999, Nitta reported 23 cases of chronic
atrial fibrillation and mitral valve disease, 10 patients were treated with
radioactive incision and suture removal maze Maze III, 13 cases of suture
removal, have made a mitral valve repair or replacement and (or) aortic valve
replacement. no early death, the cure rate after atrial incision in the
radioactivity of 90%, 92.3% maze suture removal, the right efficacy of atrial
transport does not differ between the two, radioactive incision after the peak
flow velocity of atrial filling wave / early filling wave were significantly
greater than the maze of suture removal, 0.58 and 0.25, respectively, left
atrial ejection fraction was significantly greater than the latter,
respectively, 28.5% and 15.1%.

In short, the maze III, suture removal, radioactive maze incision suture
removal, suture removal of the left and right need to be cut and stitched,
have the complexity of suture removal, suture removal long time, postoperative
complications, particularly high rate of postoperative bleeding and sick Doufa
Sheng shortcomings, apply only a small number of medical centers, it is
difficult to promote.

suture removal and evaluation of modified maze

nearly 6 years, many domestic and foreign cardiac surgeons abandoned incision
/ suture method to simplify the maze suture removal, application of freezing,
RF and microwave ablation for suture removal improved the maze.

1, frozen ablation

cryoablation therapy by applying liquid nitrogen or carbon dioxide gas by the
probe acting on the heart muscle, temperature -60 degrees, the time for 2-3
minutes. tissue injury the first 24 hours of ice Results / dissolution, 48
hours after the inflammation / hemorrhage and 12 weeks of tissue fibrosis and
scar, prevent electrical conductivity. to maintain its strength as the basic
organizational structure, resulting in symmetrical muscle cell damage, while
the collagen fibers are not affected, melting parts of the organizational
framework intact, the formation of scar will not split parts of the
endometrial ablation is not subject to injury, thrombosis is minimal. drawback
is that sometimes damage can not be frozen through the entire muscle, tissue,
after thawing can cause relapse. 40 cases reported in 2002 Yamauch 60
electrodes in the atrial application Epicardial Mapping the left atrium under
the local ablation, while 36 patients had mitral valve suture removal, the
other 4 cases of atrial septal defect and aortic valve stenosis and atrial
septal defect removal of stitches. incision left atrium after cardiac arrest
for local frozen, after restoration of sinus rhythm in 9 cases, 2 cases of
permanent pacing in sick sinus. The remaining 29 cases of mitral annulus
through the left lung from the upper and lower right pulmonary vein and down
through the top of the vein to the left atrium posterior wall of left atrium
two longitudinal lines frozen, no postoperative deaths, 31 cases (77.3%),
sinus rhythm, 6 patients and 3 patients with atrial fibrillation is still
pacing.
2, radiofrequency ablation

radiofrequency ablation is the application of vibration energy elements, parts
of the probe contact with atrial wall temperature is 50-60 degrees, time of
90-120 seconds. tissue response to regional myocardial coagulation,
destruction of cells and collagen fibers produce irreversible damage, the
number of weeks after the formation of scar, its shortcomings can not
guarantee parts of the probe can access through the atrial wall, as well as
the risk of perforation. radiofrequency ablation line more for the eyes of a
child-shaped line around the upper and lower pulmonary veins on both sides of
the oval-shaped ring to make a by which route to connect to the mitral annular
ring; two routes for the horse

				
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