Atrial fibrillation permanent

Atrial fibrillation is classified as paroxysmal, persistent, or permanent (Fig. 6-4).23 Patients with paroxysmal AF have episodes that start suddenly and spontaneously, last minutes... 

FIGURE 6-6. Decision algorithm for long-term ventricular rate control with oral drug therapy for patients with paroxysmal or permanent atrial fibrillation, bpm, beats per minute CCB, calcium channel blocker (diltiazem or verapamil) HF, heart failure LV, left ventricular function LVEF, left ventricular ejection fraction. (Algorithm adapted with permission from Tisdale JE, Moser LR. Tachyarrhythmias. In Mueller BA, Bertch KE, Dunsworth TS, et al. (eds.) Pharmacotherapy Self-Assessment Program, 4th ed. Kansas City American College of Clinical Pharmacy 2001 ... 

Rhythm control is not recommended as first line treatment in older people with persistent AF and all patients with permanent AF, as rate control would be the preferred treatment. If a patient requires rhythm control, referral to a specialist is recommended rather than commencing in primary care. At least one meta-analysis has shown that, in people with atrial fibrillation at moderate to high risk of stroke, survival rates were similar for rate control or rhythm control. 

Brignole M, Gammage M, Puggioni E, et al. Comparative assessment of right, left, and biventricular pacing in patients with permanent atrial fibrillation. Eur Heart J 2005 26 712-22. 

A 70-year-old man with hypertension, congestive heart failure, atrial fibrillation, gastroesophageal refiux disease, chronic obstructive pulmonary disease, and chronic hepatitis C infection was stabilized on warfarin 36 mg/ week. He developed a hepatocellular carcinoma and started to take sorafenib 200 mg/ day. After 1 month his prothrombin time had risen to 85 s and his INR was 40. Sorafenib and warfarin were withdrawn, and after reintroduction of warfarin his INR stabilized on a dosage of 36 mg/week. Sorafenib 200 mg/ day was again introduced, and about 2 weeks later the INR rose to 4.7. Sorafenib was withdrawn permanently. 

Atrial fibrillation/flutter with AV block or slow ventricular response (representing only 10-15% of patients requiring permanent pacing) constitutes the only indication for the VVI or VVIR pacing mode (35). Replacement of a depleted... 

Leclercq C, Walker S, Linde C, Clementy J, Marshall AJ, Ritter P, Djiane P, Mabo P, Levy T, Gadler F, BaiUeul C, Daubert JC. Comparative effects of permanent biventricular and right-univentricular pacing in heart failure patients with chronic atrial fibrillation. Eur Heart J 2002 23 1780-7. 

Fragakis N, Shakespeare CF, Lloyd G, et al. Reversion and maintenance of sinus rhythm in patients with permanent atrial fibrillation by internal cardioversion followed by biatrial pacing. Pacing Clin Electrophysiol 2002 25 278-86. 

Ozcan C, Jahangir A, Friedman PA, et al. Long-term survival after ablation of the atrioventricular node and implantation of a permanent pacemaker in patients with atrial fibrillation. N Engl J Med. 2001 344 1043-51. 

Rao, H.B. and S. Saksena, Implantable defibrillators configured for hybrid therapy of persistent and permanent atrial fibrillation initial clinical experience with a novel lead system. Journal of interventional cardiac electrophysiology, 2005. 13 Suppl 1 p. 79-86. 

Observational studies A prospective, multicenter, phase Illb study evaluated safety of anidulafungin for the treatment of candidaemia or invasive candidiasis in 216 ICU patients [66 -]. Anidulafungin-related adverse effects were observed in 15.3% of the patients, and the most frequent were erythema (1.9%), hypotension, increased blood alkaline phosphatase, increased aspartate aminotransferase, diarrhoea and atrial fibrillation (each 1.4%). Fom patients (1.9%) had serious adverse effects (two convulsions, one infusion-related adverse event, one bronchospasm). Five (2.3%) patients were permanently discontinued from the study due to >1 treatment-related adverse effect. 

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