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Intravenous amiodarone persistent atrial fibrillation


Drug cardioversion of atrial fibrillation occurred in recent years, new concepts, new ideas and constant search for acting on the atrial refractory period of the Special K + channel blockers, drugs for the cardioversion of atrial fibrillation a new page. Electric shock therapy for many people unwilling to accept that some people are often due to mental stress, anesthetic failure, shock can not be, and electric shocks have increased the risk of atrial thrombus off, electric shock,[link widoczny dla zalogowanych], successful cardioversion, drugs needed to maintain sinus rhythm. The clinical study electrical cardioversion success rate was 85% -90%, drug cardioversion success rate was 70% -89%, both about the same, especially in recent years by quinidine amiodarone reduced the risk of syncope. Turn in the drug rehabilitation process, strictly indications and contraindications. AF duration, left atrial size, V wave amplitude in the f level,[link widoczny dla zalogowanych], whether the basis of valvular disease and the severity of disease is closely related with cardioversion success. Classification by VaughanWilliams amiodarone are class Ⅲ antiarrhythmic drugs, the electrophysiological effect of ATP inhibition of the enzyme is mainly Na and K +, and slow to block Ca influx, thereby prolonging the action potential phase 2 and 3-phase or absolute refractory period, but no effect on the 0 division pole, and may competitively block and B-adrenergic receptor, therefore, can slow down the ventricular and atrial heart rate and atrioventricular conduction. Meanwhile, the intravenous injection with a strong role in the expansion of coronary artery, increase coronary blood supply, reducing myocardial oxygen consumption, good for the stability of cardiac electrophysiology. Amiodarone ROS and protect heart cells from oxidative damage, but also beneficial to the cause treatment is different from oral amiodarone,[link widoczny dla zalogowanych], intravenous amiodarone high peak concentration of blood, cardiac tissue exposed to high blood concentration, it is faster onset. And in the early intravenous, mainly for anti-calcium channel blocking effect of sympathetic and do not have the class Ⅲ antiarrhythmic drug effects, it does not extend the QT interval, therefore, side effects of intravenous amiodarone were significantly less than oral. In conclusion, intravenous amiodarone cardioversion of atrial fibrillation and high success rate, safe, simple, but still need close observation,[link widoczny dla zalogowanych], continuous ECG monitoring, especially in larger doses, side effects once found, in a timely manner to avoid more severe withdrawal side effects. On the application of anticoagulant drugs, from clinical observation of sustained atrial fibrillation who l week, the day after cardioversion of atrial systolic function can be normal, atrial fibrillation for 2 weeks, one week after cardioversion, atrial contractile function to restore party for 6 weeks, atrial systolic function is one month left atrial Schedule. V. f wave size. With cardioversion of atrial fibrillation duration before resuming relations. Atrial stunning was due to the long status of the Department of atrial and atrial appendage, thrombosis. Literature, the incidence of stroke in atrial fibrillation more than five-fold increase in drugs or electric shocks before and after cardioversion, anticoagulation with anticoagulant and no incidence of thrombosis were 0.8% and 5.5%. Practice shows that most of embolism in atrial fibrillation is not just turned recovery time, but after conversion 1 ~ 6d, which shows mechanical activity later in the recovery of electrical activity, thus advocate the use of anticoagulants before and after cardioversion, The patients were taking the drug after two weeks treatment with low molecular weight heparin, followed by continuing to take aspirin, embolization did not occur. References 1 Jiang Wenping, Zhu Jun, written and other aircraft. How to treat atrial fibrillation. Chinese Journal of Cardiology, 2003,7:4832 Geng-Shan Li, Hao Ning, Hu Dayi, and so on. Recommendations on the treatment of patients with atrial fibrillation. China cardiac pacing and cardiac electrophysiology magazine, 2002,3:16 f3 Hu Dayi. Advances in the treatment of atrial fibrillation and challenges. Medical Progress, 1996,1 (3) 5 ~ 74KerinNZ, FaitelK, NainiM. TheefficacyOfintravenousamiodaronefortheconversionofchronicatrialfibrillation. Amiodaronevsquindiineforconversionofatrialfibrillation. ArchInternMed1996. 156:449 ~ 4535 Lin Hsiu-kung. Amiodarone in the anti-tachyarrhythmia of the principles and experience. Chinese Journal of Internal Medicine,[link widoczny dla zalogowanych], 1999.19:523 ~ 5256 Xu Yanling. Oral amiodarone efficacy of direct current cardioversion of atrial fibrillation increased. Foreign Medicine, CARDIOVASCULAR DISEASE, 2O0o. 27:3107 Luorui Ping. Amine iodine Si ROS: protecting myocardial cells from oxidative damage. Foreign Medicine, CARDIOVASCULAR DISEASE, 2O0o, 27:1928 Fan Wenhu. Modern treatment of atrial fibrillation. Foreign Medical Sciences. CARDIOVASCULAR DISEASE, 2o02, 6:323 (2005o105 Received) ●