Atrial fibrillation cardioversion: Difference between revisions
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| [[File:Siren.gif|30px|link=Atrial fibrillation resident survival guide]]|| <br> || <br> | |||
| [[Atrial fibrillation resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] | |||
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{{ | {{Atrial fibrillation}} | ||
{{CMG}}; '''Associate Editor(s)-In-Chief:''' {{CZ}}; [[Varun Kumar, M.B.B.S.]] {{Anahita}} | |||
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==Overview== | |||
[[Cardioversion]] is a [[medical procedure]] by which an abnormally [[fast heart rate]] ([[tachycardia]]) or [[cardiac arrhythmia]] is converted to a [[Electrical conduction system of the heart|normal rhythm]]. When [[heart rate|rate control]] is not successful enough or when it is not able to improve the [[symptoms]] of [[patients]] [[cardioversion|rhythm control]] (either [[pharmacology|pharmacological]] or electrical) should be considered. [[Atrial fibrillation electrical cardioversion|Electrical cardioversion]] involves the restoration of normal [[heart rhythm]] through the application of a [[defibrillator]]. The [[pharmacology|pharmalogical]] method is performed with usage of [[medications]], such as [[amiodarone]], [[dronedarone]], [[procainamide]], [[ibutilide]], [[propafenone]] or [[flecainide]]. Whichever method of [[cardioversion]] is used, approximately 50% of [[patients]] [[relapse]] within one year, although the continued daily use of [[mouth|oral]] [[antiarrhythmic drugs]] may extend this period. | |||
==Cardioversion== | ==Cardioversion== | ||
*When [[heart rate|rate control]] is not successful enough or when it is not able to improve the [[symptoms]] of [[patients]] [[cardioversion|rhythm control]] (either [[pharmacology|pharmacological]] or electrical) should be considered. <ref name="pmid34020968">{{cite journal| author=Perry M, Kemmis Betty S, Downes N, Andrews N, Mackenzie S, Guideline Committee| title=Atrial fibrillation: diagnosis and management-summary of NICE guidance. | journal=BMJ | year= 2021 | volume= 373 | issue= | pages= n1150 | pmid=34020968 | doi=10.1136/bmj.n1150 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34020968 }} </ref> | |||
*[[cardioversion|Rhythm control]] methods include electrical and [[Chemical substance|chemical]] [[cardioversion]] ([[pharmacology|pharmacological]]):<ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.] ''Circulation'' 114 (7):e257-354. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref><ref name='Shea2002'>{{cite journal|title=Cardioversion|journal= Circulation|year=2002|first=Julie B.|last=Shea|coauthors=William H. Maisel|volume=106|issue=22|pages=e176–8|doi=10.1161/01.CIR.0000040586.24302.B9|url=http://circ.ahajournals.org/cgi/content/full/106/22/e176|format=|accessdate=|pmid=12451016 }}</ref><ref>{{cite journal |author=Singh BN, Connolly SJ, Crijns HJ, ''et al'' |title=Dronedarone for maintenance of sinus rhythm in atrial fibrillation or flutter |journal=N. Engl. J. Med. |volume=357 |issue=10 |pages=987–99 |year=2007 |pmid=17804843 |doi=10.1056/NEJMoa054686}}</ref> | |||
** [[Atrial fibrillation electrical cardioversion|Electrical cardioversion]] involves the restoration of normal [[heart rhythm]] through the application of a [[defibrillator]]. | |||
** [[Atrial fibrillation pharmacological cardioversion|Chemical cardioversion]] is performed with usage of [[medications]], such as [[amiodarone]], [[dronedarone]], [[procainamide]], [[ibutilide]], [[propafenone]] or [[flecainide]]. | |||
*In [[patients]] with [[atrial fibrillation]] more than 48 hours or even in cases that onset of [[atrial fibrillation]] is unknown it is recommended to delay [[cardioversion]] [[treatment]] until at least 3 weeks after [[anticoagulation]] [[therapy]].<ref name="pmid34020968">{{cite journal| author=Perry M, Kemmis Betty S, Downes N, Andrews N, Mackenzie S, Guideline Committee| title=Atrial fibrillation: diagnosis and management-summary of NICE guidance. | journal=BMJ | year= 2021 | volume= 373 | issue= | pages= n1150 | pmid=34020968 | doi=10.1136/bmj.n1150 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34020968 }} </ref> | |||
*The main risk of [[cardioversion]] is [[systemic embolization]] of a [[thrombus]] ([[Thrombus|blood clot]]) from the previously fibrillating [[left atrium]]. [[Cardioversion]] should not be performed without adequate [[anticoagulation]] in [[patients]] with more than 48 hours of [[atrial fibrillation]]. [[Cardioversion]] may be performed in instances of [[atrial fibrillation]] lasting more than 48 hours if a [[transesophogeal echocardiogram]] ([[transesophogeal echocardiogram|TEE]]) demonstrates no evidence of [[clot]] within the [[heart]].<ref name="pmid16908781"/> | |||
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*Whichever method of [[cardioversion]] is used, approximately 50% of [[patients]] [[relapse]] within one year, although the continued daily use of [[mouth|oral]] [[antiarrhythmic drugs]] may extend this period. | |||
* | *The key [[risk factor]] for relapse is duration of [[atrial fibrillation]]. Other [[risk factors]] that have been identified include the presence of [[structural heart disease]], and [[old age]]. | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
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[[CME Category::Cardiology]] | |||
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[[Category:Electrophysiology]] | [[Category:Electrophysiology]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
Latest revision as of 21:11, 27 October 2021
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Cardioversion | |
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Risk calculators and risk factors for Atrial fibrillation cardioversion | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S. Anahita Deylamsalehi, M.D.[3]
Overview
Cardioversion is a medical procedure by which an abnormally fast heart rate (tachycardia) or cardiac arrhythmia is converted to a normal rhythm. When rate control is not successful enough or when it is not able to improve the symptoms of patients rhythm control (either pharmacological or electrical) should be considered. Electrical cardioversion involves the restoration of normal heart rhythm through the application of a defibrillator. The pharmalogical method is performed with usage of medications, such as amiodarone, dronedarone, procainamide, ibutilide, propafenone or flecainide. Whichever method of cardioversion is used, approximately 50% of patients relapse within one year, although the continued daily use of oral antiarrhythmic drugs may extend this period.
Cardioversion
- When rate control is not successful enough or when it is not able to improve the symptoms of patients rhythm control (either pharmacological or electrical) should be considered. [1]
- Rhythm control methods include electrical and chemical cardioversion (pharmacological):[2][3][4]
- Electrical cardioversion involves the restoration of normal heart rhythm through the application of a defibrillator.
- Chemical cardioversion is performed with usage of medications, such as amiodarone, dronedarone, procainamide, ibutilide, propafenone or flecainide.
- In patients with atrial fibrillation more than 48 hours or even in cases that onset of atrial fibrillation is unknown it is recommended to delay cardioversion treatment until at least 3 weeks after anticoagulation therapy.[1]
- The main risk of cardioversion is systemic embolization of a thrombus (blood clot) from the previously fibrillating left atrium. Cardioversion should not be performed without adequate anticoagulation in patients with more than 48 hours of atrial fibrillation. Cardioversion may be performed in instances of atrial fibrillation lasting more than 48 hours if a transesophogeal echocardiogram (TEE) demonstrates no evidence of clot within the heart.[2]
- Whichever method of cardioversion is used, approximately 50% of patients relapse within one year, although the continued daily use of oral antiarrhythmic drugs may extend this period.
- The key risk factor for relapse is duration of atrial fibrillation. Other risk factors that have been identified include the presence of structural heart disease, and old age.
References
- ↑ 1.0 1.1 Perry M, Kemmis Betty S, Downes N, Andrews N, Mackenzie S, Guideline Committee (2021). "Atrial fibrillation: diagnosis and management-summary of NICE guidance". BMJ. 373: n1150. doi:10.1136/bmj.n1150. PMID 34020968 Check
|pmid=value (help). - ↑ 2.0 2.1 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114 (7):e257-354. DOI:10.1161/CIRCULATIONAHA.106.177292 PMID: 16908781
- ↑ Shea, Julie B. (2002). "Cardioversion". Circulation. 106 (22): e176–8. doi:10.1161/01.CIR.0000040586.24302.B9. PMID 12451016. Unknown parameter
|coauthors=ignored (help) - ↑ Singh BN, Connolly SJ, Crijns HJ; et al. (2007). "Dronedarone for maintenance of sinus rhythm in atrial fibrillation or flutter". N. Engl. J. Med. 357 (10): 987–99. doi:10.1056/NEJMoa054686. PMID 17804843.