Chronic atrial fibrillation: a systematic review of medical heart rate control management

Nikolaidou, Theodora; Channer, Kevin S.

doi:10.1136/pgmj.2008.068908

Cited by 39 publications

(32 citation statements)

References 64 publications

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“…Często wystarcza, by zmniejszyć objawy związane z AF. W porównaniu z prewencją udaru mózgu i kontrolą rytmu serca jest dostępnych bardzo niewiele mocnych dowodów, które dostarczyłyby informacji na temat najlepszego sposobu oraz intensywności leczenia w celu kontroli częstości rytmu komór, a większość danych pochodzi z krótkoterminowych krzyżowych prób klinicznych oraz badań obserwacyjnych [41,[526][527][528]. Farmakologiczną kontrolę częstości rytmu komór -zarówno doraźnie, jak i długoterminowo -można uzyskać za pomocą beta-adrenolityków, digoksyny, antagonistów wapnia, diltiazemu i werapamilu, a także leczenia skojarzonego (tab.…”

Section: Leczenie W Celu Kontroli Częstości Rytmu Komór W Obrębie Migunclassified

“…Ze względu na ujemne działanie inotropowe należy ich unikać u pacjentów z HFrEF [222,534,535]. Werapamil i diltiazem mogą zmniejszać objawy związane z arytmią [526] w porównaniu z beta-adrenolitykami, które w jednej małej próbie klinicznej u pacjentów z grupy małego ryzyka z zachowaną LVEF ograniczały wydolność fizyczną i zwiększały stężenie peptydu natriuretycznego typu B [542].…”

Section: Antagoniści Wapnia Niebędący Pochodnymi Dihydropirydynyunclassified

“…W krzyżowej próbie klinicznej w celu oceny mechanizmów działania, przeprowadzonej w grupie 47 pacjentów z HFrEF i AF, nie stwierdzono różnic pod względem częstości rytmu komór, ciśnienia tętniczego, dystansu chodu i LVEF między leczonymi karwedilolem a leczonymi digoksyną, choć podawanie beta-adrenolityku wiązało się z większym stężeniem peptydu natriuretycznego typu B, to podczas skojarzonego leczenia karwedilolem i digoksyną nastąpił wzrost LVEF, a odstawienie digoksyny spowodowało zmniejszenie LVEF [554]. Porównań z innymi lekami stosowanymi w celu kontroli częstości rytmu komór dokonano w małych, krótkoterminowych badaniach, w których nie stwierdzono różnic lub zaobserwowano jedyne marginalne różnice wydolności fizycznej, jakości życia lub LVEF w porównaniu ze stosowaniem digoksyny [526,[554][555][556][557][558]. Mniejsze dawki digoksyny (≤ 250 mg 1 ×/d.…”

Section: Naparstnicaunclassified

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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,383

4,206

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Section: Leczenie W Celu Kontroli Częstości Rytmu Komór W Obrębie Migunclassified

Section: Antagoniści Wapnia Niebędący Pochodnymi Dihydropirydynyunclassified

Section: Naparstnicaunclassified

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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,383

4,206

View full text Add to dashboard Cite

“…In particular, we observed significant interactions for cardioversion and ablation therapy that were related to a reduced symptom burden. It is well known that AF‐related therapy helps to improve symptom burden 12, 13, 14. In a prior observational study, QoL in patients with newly diagnosed AF reached normal values under pharmacologic therapy and cardioversion 15.…”

Section: Discussionmentioning

confidence: 94%

Symptom Burden of Atrial Fibrillation and Its Relation to Interventions and Outcome in Europe

Schnabel

Pecen

Rzayeva

et al. 2018

JAHA

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BackgroundLittle is known about the association of atrial fibrillation symptom burden with quality of life and outcomes.Methods and ResultsIn the Prevention of Thromboembolic Events–European Registry in Atrial Fibrillation (n=6196 patients with atrial fibrillation; mean±SD age, 71.8±10.4 years; 39.7% women), we assessed European Heart Rhythm Association score symptoms and calculated correlations with the standardized health status questionnaire (EQ‐5D‐5L). Patients were followed up for atrial fibrillation therapies and outcomes (stroke/transient ischemic attack/arterial thromboembolism, coronary events, heart failure, and major bleeding) over 1 year. Most individuals (92%) experienced symptoms. Correlations with health status and quality of life were modest. In multivariable‐adjusted regression models, the dichotomized European Heart Rhythm Association score (intermediate/frequent versus never/occasional symptoms) was associated with cardioversions (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.01–1.45) and catheter ablation (OR, 1.97; 95% CI, 1.44–2.69), and inversely related with heart rate control (OR, 0.80; 95% CI, 0.70–0.92) and heart failure incidence (OR, 1.65; 95% CI, 1.16–2.34). Anxiety was inversely related with stroke/transient ischemic attack/arterial thromboembolism (OR, 0.55; 95% CI, 0.32–0.93), whereas chest pain related positively with coronary events (OR, 2.45; 95% CI, 1.42–4.22). Fatigue (OR, 1.84; 95% CI, 1.30–2.60), dyspnea (OR, 2.33; 95% CI, 1.63–3.33), and anxiety (OR, 1.72; 95% CI, 1.16–2.55) were associated with heart failure incidence. Palpitations were positively associated with cardioversion (OR, 1.32; 95% CI, 1.08–1.61) and ablation therapy (OR, 2.02; 95% CI, 1.48–2.76).ConclusionsA higher symptom burden, in particular palpitations, predicted interventions to restore sinus rhythm. The score itself had limited predictive value, but its individual components were related to different and specific clinical events, and may thus be helpful to target patient management.

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“…There is conflicting evidence to answer this question, although a more 'lenient' target for both resting (< 110 beats.min )1 ) and submaximal exercise (< 140 beats.min )1 ) maybe associated with better quality of life. For a review of this topic see [21][22][23]. (b) Should an attempt at delayed DC cardioversion be considered?…”

Section: Treatment Notesmentioning

confidence: 99%

Medical emergencies: atrial fibrillation and myocardial infarction

Somasundaram

Ball

2012

Anaesthesia

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SummaryIn this, the first of two article on medical emergencies, we discuss the definitions, epidemiology, pathophysiology, acute and chronic management of atrial fibrillation and acute myocardial necrosis in the peri-operative and intensive care settings. For the purposes of this article, we define a medical emergency as an acute pathophysiological process that without immediate medical treatment, will result in severe single, or multiple, organ injury, and ⁄ or death. In this series of two articles, we have attempted to describe the immediate management issues for a number of medical conditions. The topics covered are either very common and ⁄ or those whose management lacks a clear, evidence based guideline applicable to patients in intensive care or equivalent environments. We offer pragmatic advice based upon published evidence (however limited), reasoned thinking and experience. Cardiovascular emergenciesCardiovascular system failure is termed shock and can result in ischaemic injury or infarction. It is also worth noting that reperfusion injury should be considered part of the same pathophysiological continuum. In physiological terms, there are broadly six components that can fail, either singularly or in any combination. Those elements are: the circulating blood volume (preload); blood composition (viscosity and oxygen carrying capacity); heart rate (HR) and rhythm; myocardial contractility and relaxation; vascular tone (principally arterial or afterload); and the microcirculation (functional capillary density and flow rate). Regardless of the aetiology, shock requires immediate management that should be directed at all of the components affected and the underlying cause. Given the innate connectivity between these six components, a systematic approach is essential in all cases. Specific cardiovascular emergencies 1: atrial fibrillationAtrial fibrillation (AF) is the commonest cardiac arrhythmia. In the Western world, its incidence increases with age being prevalent in 0.7% of patients aged 55-59, rising to 17.8% in patients aged over 85 [1]. Such data underestimates the true prevalence as an unknown proportion of patients have asymptomatic and ⁄ or paroxysmal AF. The incidence of first diagnosis or new onset AF in the peri-operative period is reported as 5-10% in non-cardiac surgery [2] and 10-65% for cardiac surgery [2]. The epidemiology of AF in the

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Chronic atrial fibrillation: a systematic review of medical heart rate control management

Abstract: Based on the limited data available, we conclude that the combination of digoxin with either a beta-blocker or calcium antagonist should be first line management in patients with chronic atrial fibrillation.

Cited by 39 publications

References 64 publications

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Symptom Burden of Atrial Fibrillation and Its Relation to Interventions and Outcome in Europe

Medical emergencies: atrial fibrillation and myocardial infarction

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