Functional and structural changes, the enlargement of the right atrium is the background for the development of typical atrial flutter (AFL). These changes in ECG are manifested in the morphology of the initial part of the P-wave. The aim of the study was to assess the duration and morphology of the P-wave in patients with paroxysmal and persistent AFL. The study population consisted of 131 patients with AFL, 38 women and 93 men aged 66 years (60-72), divided in 62 patients with paroxysmal and 69 with persistent AFL. P-wave duration was measured with an electrophysiological system in all leads at a paper speed of 200 mm/s. The groups did differ in terms of gender (38/24 vs. 55/14, (M/F), p=0.033). Patients with persistent AF had a longer P-wave duration - 175±26.3 ms vs. 159±22.6 ms, p=0.01, and higher creatinine concentration - 1.2±0.60 mg/dl vs. 1.08±0.68 mg/dl, p=0.007. The presence and severity of interatrial conduction block (I-none, II-partial, III-total) was related to age of the patients (60.3±12.1 vs. 64.7±-8.3 vs. 68.9±9.5 years, respectively). Patients with persistent AFL show a longer P-wave compared to paroxysmal AFL, regardless of comorbidities and antiarrhythmic drugs. The arrhythmia-related longer P-wave duration should encourage the clinicians to restore sinus rhythm earlier in order to more effectively maintain it over the long term.
- MeSH
- antiarytmika terapeutické užití MeSH
- elektrokardiografie MeSH
- fibrilace síní * MeSH
- flutter síní * diagnóza farmakoterapie epidemiologie MeSH
- lidé MeSH
- srdeční síně MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- antiarytmika MeSH
Atrial fibrillation is the most common sustained arrhythmia. Because of the sub-optimal outcomes and associated risks of medical therapy as well as the recent advances in non-pharmacologic strategies, a multitude of combined (hybrid) algorithms have been introduced that improve efficacy of standalone therapies while maintaining a high safety profile. Antiarrhythmic administration enhances success rate of electrical cardioversion. Catheter ablation of antiarrhythmic drug-induced typical atrial flutter may prevent recurrent atrial fibrillation. Through simple ablation in the right atrium, suppression of atrial fibrillation may be achieved in patients with previously ineffective antiarrhythmic therapy. Efficacy of complex catheter ablation in the left atrium is improved with antiarrhythmic drugs. Catheter ablation followed by permanent pacemaker implantation is an effective and safe treatment option for selected patients. Additional strategies include pacing therapies such as atrial pacing with permanent pacemakers, preventive pacing algorithms, and/or implantable dual-chamber defibrillators are available. Modern hybrid strategies combining both epicardial and endocardial approaches in order to create a complex set of radiofrequency lesions in the left atrium have demonstrated a high rate of success and warrant further research. Hybrid therapy for atrial fibrillation reviews history of development of non-pharmacological treatment strategies and outlines avenues of ongoing research in this field.
- MeSH
- antiarytmika terapeutické užití MeSH
- fibrilace síní terapie MeSH
- flutter síní farmakoterapie MeSH
- kardiostimulace umělá MeSH
- katetrizační ablace MeSH
- kombinovaná terapie MeSH
- lidé MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
- Názvy látek
- antiarytmika MeSH
The authors investigated the long-term effect of antiarrhythmic treatment on the maintenance of the sinus rhythm in a group of 32 patients with paroxysmal atrial fibrillation and flutter where the antiarrhythmic drug was selected because of negative results of tests by programmed atrial stimulation, using the method of oesophageal stimulation. After a one-year follow up 56% of the patients had permanently a sinus rhythm without paroxysms of supraventricular arrhythmia. Comparison with results of work evaluating the effectiveness of different antiarrhythmic drugs as regards maintenance of the sinus rhythm without testing suggests that selection of an antiarrhythmic drug by programmed stimulation of the atria by oesophageal stimulation has no predictive value for the effect of antiarrhythmic treatment.
- MeSH
- antiarytmika terapeutické užití MeSH
- dospělí MeSH
- fibrilace síní farmakoterapie patofyziologie MeSH
- flutter síní farmakoterapie patofyziologie MeSH
- kardiostimulace umělá * MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- Názvy látek
- antiarytmika MeSH
Restoration of the sinus rhythm in atrial fibrillation and flutter can be achieved by cardioversion, using an electric discharge, or by medicamentous treatment. Medicamentous treatment is based above all on a combination of antiarrhythmic drugs. By the concurrent administration of quinidine, verapamil and digoxin restoration of the sinus rhythm is achieved in 80% patients, on average after 37 hours at plasma quinidine levels of 2.57 +/- 1.4 (SD) micrograms/ml and digoxin levels of 1.90 +/- 1.3 (SD) nmol/l. Restoration of the sinus rhythm in atrial flutter calls for higher quinidine and digoxin levels than in atrial fibrillation (p less than 0.01). Prolonged persistence of the sinus rhythm during treatment with maintenance doses of quinidine, verapamil and digoxin is not satisfactory so far and after 12 months the sinus rhythm persists only in 30% of the patients where the rhythm was originally restored.
- MeSH
- chinidin aplikace a dávkování terapeutické užití MeSH
- digoxin aplikace a dávkování terapeutické užití MeSH
- fibrilace síní farmakoterapie patofyziologie MeSH
- flutter síní farmakoterapie patofyziologie MeSH
- kombinovaná farmakoterapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- srdeční frekvence účinky léků MeSH
- verapamil aplikace a dávkování terapeutické užití MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- Názvy látek
- chinidin MeSH
- digoxin MeSH
- verapamil MeSH
Holter functions of pacemakers were studied in a total of nine patients with paroxysmal atrial flutter (Group I--a Quintech DD 931 pacemaker, manufactured by Vitatron Medical, The Netherlands), and in 11 patients with recurrent postinfarction ventricular tachycardia (Group II--a DPG P 21 diagnostic pulse generator, Vitatron Medical. Seven patients (35%) were excluded from the study for myopotential interference. Group I patients were given six antiarrhythmic drugs for eight weeks each, with only prajmalin and amiodarone significantly shortening flutter duration. Group II patients were administered, according to the results of programmed extrastimulation, amiodarone alone or in combination with Class I antiarrhythmic drugs for a long period of time. While no recurrent tachycardias or sudden death were noted during treatment, pacemaker detected non-lethal ventricular tachycardia occurred in two, and sudden death without confirmed arrhythmia in one patient once the treatment had been discontinued for serious side effects (p less than 0.05). Diagnostic stimulation using bipelar sensing to eliminate myopotential interference might become a major method for long-term monitoring.
- MeSH
- antiarytmika aplikace a dávkování MeSH
- elektrokardiografie přístrojové vybavení MeSH
- flutter síní diagnóza farmakoterapie MeSH
- kardiostimulátor * MeSH
- lidé MeSH
- mikropočítače * MeSH
- monitorování fyziologických funkcí přístrojové vybavení MeSH
- následné studie MeSH
- počítačové zpracování signálu MeSH
- srdeční komory účinky léků MeSH
- tachykardie diagnóza farmakoterapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
- Názvy látek
- antiarytmika MeSH
- MeSH
- dospělí MeSH
- fibrilace síní farmakoterapie MeSH
- flutter síní farmakoterapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lidoflazin terapeutické užití MeSH
- piperaziny terapeutické užití MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- Názvy látek
- lidoflazin MeSH
- piperaziny MeSH
- MeSH
- antiarytmika terapeutické užití MeSH
- beta blokátory terapeutické užití MeSH
- chinidin terapeutické užití MeSH
- digitalisové glykosidy terapeutické užití MeSH
- fibrilace síní farmakoterapie MeSH
- flutter síní farmakoterapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- antiarytmika MeSH
- beta blokátory MeSH
- chinidin MeSH
- digitalisové glykosidy MeSH
- MeSH
- antiarytmika terapeutické užití MeSH
- dospělí MeSH
- elektrokardiografie MeSH
- fibrilace síní farmakoterapie MeSH
- flutter síní farmakoterapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- srdeční frekvence MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- antiarytmika MeSH
