Ventricular Rate Response Following Exercise During Auricular Fibrillation and After Conversion to Normal Sinus Rhythm

Wetherbee, Donald G.; Brown, Morton G.; Holzman, Daniel

doi:10.1097/00000441-195206000-00010

Cited by 29 publications

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“…Knox (1949) and Wetherbee, Brown, and Holzman (1952) agreed with earlier workers, that the major disability of atrial fibrillation was the rapid ventricular rate, especially on exercise. With the establishment of sinus rhythm and consequent slowing of the heart an increased diastolic, filling time would result in a larger stroke volume and cardiac output.…”

Section: Discussionsupporting

confidence: 89%

Haemodynamic studies before and after electrical conversion of atrial fibrillation and flutter to sinus rhythm.

Resnekov¹

1967

Heart

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Section: Discussionsupporting

confidence: 89%

Haemodynamic studies before and after electrical conversion of atrial fibrillation and flutter to sinus rhythm.

Resnekov¹

1967

Heart

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“…Caution and reconsideration of the total situation should be the rule when 3 Gm./ day of quinidine does not effect conversion or when the serum concentration reaches 8 jug./ml. 13. The use of quinidine in established atrial fibrillation should be considered a calculated risk, and the physician must weigh the potential benefits against the possible hazards.…”

Section: Atrial Tachycardiamentioning

confidence: 99%

Factors Influencing Conversion of Chronic Atrial Fibrillation with Special Reference to Serum Quinidine Concentration

1956

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Opinion differs greatly about the value and risk of quinidine. The present communication attempts to demonstrate that more rational use of quinidine is possible by emphasis on serum quinidine concentration rather than on dose alone. Conversion of chronic atrial fibrillation and the appearance of myocardial toxicity are related more closely to the concentration of quinidine in the blood than to the dose. The serum concentration achieved with equal doses of the drug varied strikingly in different individuals; myocardial toxicity was infrequent at levels less than 6.0 ,g./ml. and increased proportionately as this level was exceeded. These levels could not always be predicted from the dose given. 2. Chronic cardiac "invalids" despite full cardiac therapy in whom it was thought that increased cardiac output associated with sinus rhythm might improve cardiac function.3. Those with atrial fibrillation and episodes of arterial emboli, in whom it was thought that restoration to sinus rhythm might decrease the likelihood of atrial thrombus formation.4. Those with chronic atrial fibrillation who had undergone a technically successful mitral valvulotomy.5. Those in whom atrial fibrillation persisted after successful treatment of hyperthyroidism.6. Those with atrial fibrillation of relatively recent origin (less than 6 months), regardless of symptoms and of the underlying disease.7. Those in whom disturbing palpitations and awareness of cardiac irregularity persisted despite full digitalization and a slow ventricular rate.As a general rule, conversion to sinus rhythm was not attempted in middle-aged or elderly patients with chronic atrial fibrillation who were entirely asymptomatic, who had been doing well on digitalis alone, and who had not experienced any cardiac difficulties or emboli over a period of months or years despite the arrythmia.Patients with paroxysmal atrial fibrillation are not considered in the present paper.Etiology

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“…Hemodynamic studies before and after conversion from atrial fibrillation to sinus rhythm with quinidine by Kerkhof (1936), Kory and Meneely (1951), Hecht, Osher, and Samuels (1951), Hansen, McClendon, and Kinsman (1952), Wetherbee, Brown, andHolzman (1952), Broch andMuller (1957), and Selzer (1960) have all shown the advantages of sinus rhythm, but Selzer has questioned the extent to which such differences can affect the patients symptomatically. Hecht and Lange (1956) have stressed the advantage of controlled atrial fibrillation over less well-controlled sinus tachycardia.…”

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confidence: 99%

The Prognosis of Atrial Fibrillation Following Mitral Valvotomy

Bloom¹

1963

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The incidence of sinus rhythm in patients submitted to mitral valvotomy varies between 40 and 60 per cent. In this group atrial fibrillation occurs in the post-operative period in 20 to 50 per cent (Sellors, Bedford, and Somerville, 1953; Wood, 1954 a and b; Dimond and dos Santos, 1954;Heinz and Hultgren, 1957;Ellis, Harken, and Black, 1959;Kittle and Crockett, 1959;Baker and Hancock, 1960;Lowther and Turner, 1962;Black, Lown, and Bartholomay, 1961). The prognosis of atrial fibrillation after mitral valvotomy with and without quinidine therapy is examined in this paper.Subjects. The cardiac rhythms as confirmed by the electrocardiograms of the 331 patients who underwent their first mitral valvotomy at Hammersmith Hospital between 1951 and 1962 were studied. Of these patients, 151 (45%) were in sinus rhythm, 179 (550o) were in atrial fibrillation, and one was in atrial flutter. Post-operative rhythm changes were always confirmed by the cardiogram. RESULTSPatients in Sinus Rhythm at Mitral Valvotomy. Of the patients who underwent their first valvotomy, 151 were in sinus rhythm and none was given prophylactic quinidine. Forty-six patients developed atrial fibrillation in the post-operative period and 27 of these were treated with digitalis alone; 12 of the 27 (440 %) reverted to sinus rhythm spontaneously, 8 within the first two postoperative weeks, 2 at five weeks, 1 at eleven weeks, and 1 at six months.An attempt to recognize features favouring the spontaneous reversion to normal rhythm revealed that where atrial fibrillation developed in the first post-operative week (19 patients), 12 (60%) reverted to normal rhythm; but where atrial fibrillation developed after the first post-operative week (8 patients), none reverted spontaneously to normal rhythm (Table I). The cardio-thoracic ratio, pre-operative electrocardiographic evidence of right ventricular hypertrophy, other valve lesions,

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Ventricular Rate Response Following Exercise During Auricular Fibrillation and After Conversion to Normal Sinus Rhythm

Cited by 29 publications

References 0 publications

Haemodynamic studies before and after electrical conversion of atrial fibrillation and flutter to sinus rhythm.

Haemodynamic studies before and after electrical conversion of atrial fibrillation and flutter to sinus rhythm.

Factors Influencing Conversion of Chronic Atrial Fibrillation with Special Reference to Serum Quinidine Concentration

The Prognosis of Atrial Fibrillation Following Mitral Valvotomy

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