Daily Archive 06.01.2019

Atrial fibrillation in mitral stenosis.

Atrial fibrillation in mitral stenosis.

Atrial fibrillation in itself is not life threatening. The prognosis is usually relatively favorable, even considering the risk of arterial thromboembolism. About 10% of patients develop heart failure. Mortality of patients with atrial fibrillation is 1.5-1.9 times higher than mortality in the population as a whole.

For the treatment of patients with atrial fibrillation, it is recommended to first translate the tachyarrhythmic form of blink into normal arrhythmic with the help of drugs (for example, cardiac glycosides, verapamil, beta-adrenergic receptor blockers) and at the same time to prescribe anticoagulant therapy. Then it is necessary to clarify the cause of atrial fibrillation and, depending on this cause (for example, valve defect or hyperthyroidism), to perform a surgical intervention or to select a medical therapy.

In the absence of a reason that can be directly affected, the patient’s data should be discussed in order to present what the prospects for drug or electrical cardioversion are and how appropriate they are. This primarily depends on how long the atrial fibrillation lasts (for example, less than 6 months or more than this period), how much the LP is increased (for example, does its diameter exceed 50 mm or is it less than 50 mm) and does flicker manifest Atrial clinical symptoms.

If you intend to perform cardioversion, then for 3 weeks. before the proposed date of this treatment procedure, the patient is prescribed anticoagulants and, only after achieving effective hypocoagulation, they proceed to medication (using flecainide, etacizin, propafenone, beta-adrenergic receptor blockers, cardiac glycosides, amiodarone, and new drugs of dronedarone or vernacalanta) or an electric cardiac glycoside, amiodarone, and new drugs of dronedarone or vernacalanta or an electric cardonic glucoside, amiodarone, and new dronedarone or vernacalanta treatment. Additionally prescribe drugs that stabilize the rhythm of heart contractions.

Patients whose rhythm disturbance is asymptomatic, elderly patients, as well as those for whom, based on the above criteria, cardioversion seems to have little promise, after long-term anticoagulant therapy should be treated only with heart rhythm-stabilizing drugs, in particular beta-adrenergic receptor blockers or cardiac glycosides.

Patients with clinical manifestations of atrial fibrillation, resistant to drug or electrical cardioversion, can be X-ray-surgical isolation of the orifices of the pulmonary veins by radiofrequency ablation or cryodestruction. Successful results after such interventions are observed in 70% of patients.

The auricle of the left atrium (LP) is the most frequent site of the formation of blood clots, which become the source of thromboembolism. Recently, a new method of treatment has been developed, which made it possible to reduce the risk of thromboembolism in patients with atrial fibrillation, which can be used especially in cases where the administration of anticoagulant therapy is contraindicated. With this method of treatment, which is abbreviated as PLAATO, the ear of the brain is isolated from its cavity by implanting an umbrella-like device into the atrium using catheter technology.