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Reynaldo G, Hamonangan R, Naomi P, Widjanarko ND. High-Dose Oral Amiodarone for Cardioversion of Atrial Fibrillation: A Case Report. Cureus 2023; 15:e41766. [PMID: 37575716 PMCID: PMC10416672 DOI: 10.7759/cureus.41766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
With the rising prevalence of atrial fibrillation (AF), it has become a global health problem with increasing complications and high medical costs. Here, we describe the case of a 52-year-old woman with chest discomfort and frequent palpitations for the last few months. A careful clinical and instrumental examination showed that the patient had AF. Sinus rhythm was restored by cardioversion using high-dose oral amiodarone therapy. Although this medication can be an alternative with several advantages over electrical cardioversion in the future, further studies are needed to establish its efficacy and safety profile.
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Affiliation(s)
| | | | - Pingkan Naomi
- General Practice, Atma Jaya Catholic University, Jakarta, IDN
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2
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Lv W, Wang X, Liu J, Yu P. Eight-Section Brocade Exercises Improve the Sleep Quality and Memory Consolidation and Cardiopulmonary Function of Older Adults With Atrial Fibrillation-Associated Stroke. Front Psychol 2019; 10:2348. [PMID: 31695645 PMCID: PMC6818461 DOI: 10.3389/fpsyg.2019.02348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/02/2019] [Indexed: 12/21/2022] Open
Abstract
Purpose: Poor sleep quality is harmful for everyone and potentially even more harmful for older adults with atrial fibrillation-associated stroke (AFAS). This study aims to explore the effects of eight-section brocade (ESB) on sleep quality, memory, and cardiopulmonary function in the older adults with AFAS. Methods: Older adults with AFAS and sleep disorders were recruited and divided into the ESB (EG, n = 85) and control groups (CG, general exercise, n = 85). EG patients received 60 min ESB exercises 5 times a week for 12 weeks; CG patients received normal exercise. Pittsburgh sleep quality index (PSQI) scores (poor sleepers ≥8 and normal sleepers < 8), memory for word pairs (poor memory ≤ 7 and normal memory > 7), left ventricular posterior wall (LVPW) thickness, and maximum ventilation (MV, to evaluate cardiopulmonary function) values were measured. The correlation between sleep and memory quality was analyzed using PSQI scores and word pairs via the Pearson correlation coefficients test. Adjusted Cox models were used to explore an interaction between PSQI and ESB exercise. Results: After 12-week exercise intervention, ESB improved sleep quality, latency, duration, disturbance and daytime dysfunction when compared to conventional exercise. In similar cases, the MV values in the EG were also higher than that in the CG (p = 0.009). ESB intervention could not affect the cardiac structure and left ventricular ejection fraction. Compared with the CG, the ESB intervention reduced PSQI scores and increased memorized word pairs (p < 0.001 for poor and normal sleepers in both unadjusted and adjusted analysis, p = 0.012 and 0.003 for poor and normal memory). The test of Pearson correlation coefficients showed that PSQI scores were strongly associated with the number of word pairs in both unadjusted and adjusted analyses (p < 0.0001). Conclusion: Eight-section brocade exercise improved sleep quality and memory consolidation and cardiopulmonary function by reducing PSQI scores, increasing word pairs and MV values in the older adults with AFAS.
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Affiliation(s)
- Wei Lv
- Department of Cadre Ward, The First Hospital of Jilin University, Changchun, China
| | - Xinxin Wang
- Department of Cadre Ward, The First Hospital of Jilin University, Changchun, China
| | - Jia Liu
- Department of Cardiovascular Medicine, The First Hospital of Jilin University, Changchun, China
| | - Ping Yu
- Department of Cardiovascular Medicine, The First Hospital of Jilin University, Changchun, China
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AlHabeeb W, Al-Ayoubi F, AlGhalayini K, Al Ghofaili F, Al Hebaishi Y, Al-Jazairi A, Al-Mallah MH, AlMasood A, Al Qaseer M, Al-Saif S, Chaudhary A, Elasfar A, Tash A, Arafa M, Hassan W. Saudi Heart Association (SHA) guidelines for the management of heart failure. J Saudi Heart Assoc 2019; 31:204-253. [PMID: 31371908 PMCID: PMC6660461 DOI: 10.1016/j.jsha.2019.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 05/31/2019] [Accepted: 06/18/2019] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) is the leading cause of morbidity and mortality worldwide and negatively impacts quality of life, healthcare costs, and longevity. Although data on HF in the Arab population are scarce, recently developed regional registries are a step forward to evaluating the quality of current patient care and providing an overview of the clinical picture. Despite the burden of HF in Saudi Arabia, there are currently no standardized protocols or guidelines for the management of patients with acute or chronic heart failure. Therefore, the Heart Failure Expert Committee, comprising 13 local specialists representing both public and private sectors, has developed guidelines to address the needs and challenges for the diagnosis and treatment of HF in Saudi Arabia. The ultimate aim of these guidelines is to assist healthcare professionals in delivering optimal care and standardized clinical practice across Saudi Arabia.
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Affiliation(s)
- Waleed AlHabeeb
- Cardiac Sciences Department, King Saud University, Riyadh, Saudi ArabiaSaudi Arabia
- Corresponding author at: Cardiac Sciences Department, King Saud University, P.O. Box 7805, Riyadh 11472, Saudi Arabia.
| | - Fakhr Al-Ayoubi
- King Fahad Cardiac Center, King Saud University, Riyadh, Saudi ArabiaSaudi Arabia
| | - Kamal AlGhalayini
- King Abdulaziz University Hospital, Jeddah, Saudi ArabiaSaudi Arabia
| | - Fahad Al Ghofaili
- King Salman Heart Center, King Fahad Medical City, Riyadh, Saudi ArabiaSaudi Arabia
| | | | - Abdulrazaq Al-Jazairi
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaSaudi Arabia
| | - Mouaz H. Al-Mallah
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi ArabiaSaudi Arabia
| | - Ali AlMasood
- Riyadh Care Hospital, Riyadh, Saudi ArabiaSaudi Arabia
| | - Maryam Al Qaseer
- King Fahad Specialist Hospital, Dammam, Saudi ArabiaSaudi Arabia
| | - Shukri Al-Saif
- Saud Al-Babtain Cardiac Center, Dammam, Saudi ArabiaSaudi Arabia
| | - Ammar Chaudhary
- King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi ArabiaSaudi Arabia
| | - Abdelfatah Elasfar
- Madina Cardiac Center, AlMadina AlMonaoarah, Saudi ArabiaSaudi Arabia
- Cardiology Department, Tanta University, EgyptEgypt
| | - Adel Tash
- Ministry of Health, Riyadh, Saudi ArabiaSaudi Arabia
| | - Mohamed Arafa
- Cardiac Sciences Department, King Saud University, Riyadh, Saudi ArabiaSaudi Arabia
| | - Walid Hassan
- International Medical Center, Jeddah, Saudi ArabiaSaudi Arabia
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Providencia R, Chew D, Taylor J, Kukendra-Rajah K, Papageorgiou N, Ioannou A, Mead GE, Nevis IIF, Wilton SB, Lambiase P, Morillo CA. External electrical and pharmacological cardioversion for atrial fibrillation, atrial flutter or atrial tachycardias: a network meta-analysis. Hippokratia 2019. [DOI: 10.1002/14651858.cd013255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Rui Providencia
- St Bartholomew's Hospital, Barts Health NHS Trust; Barts Heart Centre; London UK
| | - Derek Chew
- University of Calgary; Libin Cardiovascular Institute; Calgary Canada
| | - Julie Taylor
- University College London; Institute of Health Informatics Research; London UK
| | | | | | - Adam Ioannou
- Royal Free London NHS Foundation Trust; London UK
| | - Gillian E Mead
- University of Edinburgh; Centre for Clinical Brain Sciences; Room S1642, Royal Infirmary Little France Crescent Edinburgh UK EH16 4SA
| | - Immaculate IF Nevis
- London Health Sciences; Psychiatry; 62 Fitzwilliam Blvd London ON Canada N6H 5H6
| | - Stephen B Wilton
- University of Calgary; Libin Cardiovascular Institute; Calgary Canada
| | - Pier Lambiase
- The Heart Hospital, University College London Hospitals; Centre for Cardiology in the Young; 16-18 Westmoreland Street, London UK W1G 8PH
| | - Carlos A Morillo
- Foothills Medical Centre; Department of Cardiac Sciences, Cumming School of Medicine; C849 1403 29th Street NW Calgary Alberta Canada T2N 2T9
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Lin JHI, Kean AC, Cordes TM. The Risk of Thromboembolic Complications in Fontan Patients with Atrial Flutter/Fibrillation Treated with Electrical Cardioversion. Pediatr Cardiol 2016; 37:1351-60. [PMID: 27421846 DOI: 10.1007/s00246-016-1441-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 06/23/2016] [Indexed: 01/17/2023]
Abstract
Atrial flutter or fibrillation (AFF) remains a major chronic complication of the Fontan procedure. This complication further predisposes this patient population to thromboembolic events. However, the incidence of thromboembolic complications in Fontan patients with AFF prior to or acutely after electrical cardioversion is unknown. This study aimed to characterize the risk of post-cardioversion thromboembolic events in this population. We performed a retrospective medical record review of all patients with a history of Fontan operation treated with direct current cardioversion for AFF at Riley Children's Hospital between June 1992 and March 2014. A total of 57 patients were identified and reviewed. A total of 216 episodes of AFF required electrical cardioversion. Patients were treated with anticoagulation/antiplatelet therapy in 86.1 % (N = 186) of AFF episodes. Right atrial or Fontan conduit clots were observed in 33 patients (57.9 %) with 61 episodes of AFF. Approximately half (49.2 %, N = 30) of these episodes were treated immediately with electrical cardioversion. Twenty-five of 33 (75.8 %) patients with intracardiac thrombi had an atriopulmonary Fontan. Five (15.2 %) patients with a lateral caval tunnel had clots in the Fontan conduit, and three (9.1 %) patients with right atrium to right ventricular outflow tract (RVOT) connections presented with right atrial mural thrombi. Nine of the 57 (15.8 %) patients had documented stroke, and three (5.3 %) patients had pulmonary emboli during follow-up, although none of these emboli were associated with electrical cardioversion. The risk of thrombus and thromboembolism associated with AFF is high in the Fontan population. However, the risk of thromboembolism associated with cardioversion in the setting of anticoagulation is very low.
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Affiliation(s)
- Jiuann-Huey I Lin
- Division of Pediatric Cardiology, Department of Pediatrics, Indiana School of Medicine, 705 Riley Hospital Drive, RR 227, Indianapolis, IN, 46202-5225, USA.,Division of Pediatric Cardiac Critical Care, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Adam C Kean
- Division of Pediatric Cardiology, Department of Pediatrics, Indiana School of Medicine, 705 Riley Hospital Drive, RR 227, Indianapolis, IN, 46202-5225, USA
| | - Timothy M Cordes
- Division of Pediatric Cardiology, Department of Pediatrics, Indiana School of Medicine, 705 Riley Hospital Drive, RR 227, Indianapolis, IN, 46202-5225, USA.
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Bellew SD, Bremer ML, Kopecky SL, Lohse CM, Munger TM, Robelia PM, Smars PA. Impact of an Emergency Department Observation Unit Management Algorithm for Atrial Fibrillation. J Am Heart Assoc 2016; 5:JAHA.115.002984. [PMID: 26857070 PMCID: PMC4802469 DOI: 10.1161/jaha.115.002984] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Atrial fibrillation (AF) is a common, growing, and costly medical condition. We aimed to evaluate the impact of a management algorithm for symptomatic AF that used an emergency department observation unit on hospital admission rates and patient outcomes. Methods and Results This retrospective cohort study compared 563 patients who presented consecutively in the year after implementation of the algorithm, from July 2013 through June 2014 (intervention group), with 627 patients in a historical cohort (preintervention group) who presented consecutively from July 2011 through June 2012. All patients who consented to have their records used for chart review were included if they had a primary final emergency department diagnosis of AF. We observed no significant differences in age, sex, vital signs, body mass index, or CHADS2 (congestive heart failure, hypertension, age, diabetes mellitus, and prior stroke or transient ischemic attack) score between the preintervention and intervention groups. The rate of inpatient admission was significantly lower in the intervention group (from 45% to 36%; P<0.001). The groups were not significantly different with regard to rates of return emergency department visits (19% versus 17%; P=0.48), hospitalization (18% versus 16%; P=0.22), or adverse events (2% versus 2%; P=0.95) within 30 days. Emergency department observation unit admissions were 40% (P<0.001) less costly than inpatient hospital admissions of ≤1 day's duration. Conclusions Implementation of an emergency department observation unit AF algorithm was associated with significantly decreased hospital admissions without increasing the rates of return emergency department visits, hospitalization, or adverse events within 30 days.
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Affiliation(s)
- Shawna D Bellew
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN
| | - Merri L Bremer
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - Christine M Lohse
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Thomas M Munger
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Paul M Robelia
- Department of Family Medicine, Mayo Clinic, Rochester, MN
| | - Peter A Smars
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN
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Lou KKW, Egan G, Tejani AM. The use of antiarrhythmics prior to cardioversion or catheter ablation for atrial fibrillation. Hippokratia 2015. [DOI: 10.1002/14651858.cd010380.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Kelvin Ka Weng Lou
- University of British Columbia; Faculty of Medicine; Vancouver BC Canada V6T 1Z3
| | - Gregory Egan
- Lower Mainland Pharmacy Services; 330 East Columbia Street New Westminster BC Canada
| | - Aaron M Tejani
- University of British Columbia; Therapeutics Initiative; 2176 Health Sciences Mall Vancouver BC Canada V6T 1Z3
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Abstract
BACKGROUND Atrial fibrillation (AF) is the most common cardiac arrhythmia seen in cardiovascular departments. Treatments include medical interventions and catheter ablation. Due to uncertainties in medical therapies for AF, and the need to continue sinus rhythm, ablation has been recently considered as a viable alternative. Many new ablation methods based on pulmonary vein isolation (PVI) have been developed. OBJECTIVES The primary objective of this review was to assess the beneficial and harmful effects of catheter ablation (CA) in comparison with medical treatment in patients with paroxysmal and persistent AF. The secondary objective was to determine the best regimen of CA. SEARCH METHODS Searches were run on The Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library Issue 3 2009, MEDLINE (1950 to August 2009), EMBASE (1980 to August 2009), the Chinese Biomedical Literature Database (1978 to August 2009) and the CKNI Chinese Paper Database (1994 to 2009) . Several journals published in Chinese were also handsearched. SELECTION CRITERIA Randomised controlled trials (RCTs) in people with paroxysmal and persistent AF treated by any type of CA method. Two reviewers independently selected the trials for inclusion. DATA COLLECTION AND ANALYSIS Assessments of risk of bias were performed by two reviewers, and relative risk (RR) and 95% confidence intervals (CI) were used for dichotomous variables. Meta-analysis were performed where appropriate. MAIN RESULTS A total of 32 RCTs (3,560 patients) were included. RCTs were small in size and of poor quality.CA compared with medical therapies: seven RCTs indicated that CA had a better effect in inhibiting recurrence of AF [RR 0.27; 95% CI 0.18, 0.41)] but there was significant heterogeneity. There was limited evidence to suggest that sinus rhythm was restored during CA (one small trial: RR 0.28, 95% CI 0.20-0.40), and at the end of follow-up (RR 1.87, 95% CI 1.31-2.67; I(2)=83%). There were no differences in mortality (RR, 0.50, 95% CI 0.04 to 5.65), fatal and non-fatal embolic complication (RR 1.01, 95% CI 0.18 to 5.68) or death from thrombo-embolic events (RR 3.04, 95% CI 0.13 to 73.43).Comparisons of different CAs; 25 RCTs compared CA of various kinds. Circumferential pulmonary vein ablation was better than segmental pulmonary vein ablation in improving symptoms of AF (p<=0.01) and in reducing the recurrence of AF (p<0.01). There is limited evidence to suggest which ablation method was the best. AUTHORS' CONCLUSIONS There is limited evidence to suggest that CA may be a better treatment option compared to medical therapies in the management of persistent AF. This review was also unable to recommend the best CA method.
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Affiliation(s)
- Huai Sheng Chen
- Intensive Care Unit, Shenzhen People’s Hospital, The Second Affiliated Hospital of JiNan University, Shenzhen City,
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Hassantash SA, Kalantarian S, Bikdeli B, Sadeghian M, Kasraii F, Haghdoost A. Surgical ablation for atrial fibrillation. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2008. [DOI: 10.1002/14651858.cd007318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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