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Tachycardia: Difference between revisions
→Long-Term Management:
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** <b>Invasive treatment:</b> | ** <b>Invasive treatment:</b> | ||
*** <b>His-Ablation with pacemaker implantation: </b>Patients with accepted atrial fibrillation and complaints of a fast irregular ventricular frequency who do not tolerate medication can be helped with a targeted His bundle ablation with catheter ablation to induce complete AV-block. A implanted pacemaker can take over the ventricular firing frequency independent of the atrium. A pacemaker might be indicated if rate control leads to a iatrogenic bradycardia. | *** <b>His-Ablation with pacemaker implantation: </b>Patients with accepted atrial fibrillation and complaints of a fast irregular ventricular frequency who do not tolerate medication can be helped with a targeted His bundle ablation with catheter ablation to induce complete AV-block. A implanted pacemaker can take over the ventricular firing frequency independent of the atrium. A pacemaker might be indicated if rate control leads to a iatrogenic bradycardia. | ||
* <b>Rhythm control:</b> In rhythm control all efforts are made to achieve and maintain sinus rhythm. This can be done with anti-arrhythmic drugs. Most effective are the Class IC and III anti-arrhythmic drugs.<cite>Lafuente</cite> Overall rhythm control is difficult and anti-arrhythmic drugs might have (pro-arrhythmic) side effects, if patients have contra-indications.<cite>Echt, Roy1</cite> Therefore prescription of these drugs should occur with caution. | * <b>Rhythm control:</b> In rhythm control all efforts are made to achieve and maintain sinus rhythm. This can be done with anti-arrhythmic drugs. Most effective are the Class IC and III anti-arrhythmic drugs.<cite>Lafuente</cite> Overall rhythm control is difficult and anti-arrhythmic drugs might have (pro-arrhythmic) side effects, if patients have contra-indications.<cite>Echt, Roy1</cite> Therefore prescription of these drugs should occur with caution. If patiens experience serious side effects of anti-arrhythmic drugs or have a low frequency of AF episoded an one month treatment with anti-arrhythmic drugs after cardioversion can prevent the majority of recurrences.<cite>Kirchhof</cite> Amiodarone is unsuitable for short-term treatment due to its pharmacological properties.<cite>Ahmed</cite> | ||
** <b>Invasive treatment:</b><cite>Calkins</cite> | ** <b>Invasive treatment:</b><cite>Calkins</cite> | ||
*** <b>Catheter ablation:</b> Medical therapy is not always sufficient to maintain sinus rhythm. In the last decade of 20th century it was discovered that atrial fibrillation is triggered from the pulmonary veins and that selective ablation of these trigger sites can reduce atrial fibrillation recurrence.<cite>Hais</cite> As this technique evolved it is now common to ablate an area around the pulmonary veins to isolate them from the atrial tissue. The left atrium is approached through the inter-atrial septum and with the use of imaging and electrocardiographic signals a 3D map is made to navigate the atria. The pulmonary vein isolation can be performed with multiple energy sources (cryo-cooling, radiofrequent energy). This is a complex procedure, that depending on the technique used has a minor chance of (severe) complications, primarily caused by damage of the surrounding structures. The success rate of the procedure varies on the experience of the operator and is 57-71% after one or more procedures.<cite>Calkins2,Cappato</cite> Catheter ablation is suitable for patients with a with drug-refratory rhythm control strategy.<cite>Nielsen</cite> Certain selected patients with heart failure might benefit from catheter ablation, although success are lower.<Cite>Khan,Hsu</Cite> | *** <b>Catheter ablation:</b> Medical therapy is not always sufficient to maintain sinus rhythm. In the last decade of 20th century it was discovered that atrial fibrillation is triggered from the pulmonary veins and that selective ablation of these trigger sites can reduce atrial fibrillation recurrence.<cite>Hais</cite> As this technique evolved it is now common to ablate an area around the pulmonary veins to isolate them from the atrial tissue. The left atrium is approached through the inter-atrial septum and with the use of imaging and electrocardiographic signals a 3D map is made to navigate the atria. The pulmonary vein isolation can be performed with multiple energy sources (cryo-cooling, radiofrequent energy). This is a complex procedure, that depending on the technique used has a minor chance of (severe) complications, primarily caused by damage of the surrounding structures. The success rate of the procedure varies on the experience of the operator and is 57-71% after one or more procedures.<cite>Calkins2,Cappato</cite> Catheter ablation is suitable for patients with a with drug-refratory rhythm control strategy.<cite>Nielsen</cite> Certain selected patients with heart failure might benefit from catheter ablation, although success are lower.<Cite>Khan,Hsu</Cite> | ||