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Tachycardia: Difference between revisions
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Atrial fibrillation can be managed with anti-arrhythmic medication or more invasive treatment strategies. Studies have shown no benefit of rhyhtm control over rate control, thus the selection of strategy is mainly dependent of patient and atrial fibrillation characteristics. Independent of the treatment strategy, proper anti-coagulation is important and necessary in patients with risk factors. | Atrial fibrillation can be managed with anti-arrhythmic medication or more invasive treatment strategies. Studies have shown no benefit of rhyhtm control over rate control, thus the selection of strategy is mainly dependent of patient and atrial fibrillation characteristics. Independent of the treatment strategy, proper anti-coagulation is important and necessary in patients with risk factors. | ||
* <B>Rate control:</b> In atrial fibrillation the ventricle can have a fast irregular rate that can be difficult to tolerate by a patient. On of the strategies in managing atrial fibrillation is to control ventricular rate <120bpm. In this strategy no attempt is made to achieve sinus rhythm. This is the only treatment option in patients with permanent atrial fibrillation. Due to the fast irregular ventricular rate a dilated tachycardiomyopathy can develop and proper rate control can revert these ventricular changes. Rate control can be achieved with beta-blockers, Ca-antagonist and digoxine. | * <B>Rate control:</b> In atrial fibrillation the ventricle can have a fast irregular rate that can be difficult to tolerate by a patient. On of the strategies in managing atrial fibrillation is to control ventricular rate <120bpm. In this strategy no attempt is made to achieve sinus rhythm. This is the only treatment option in patients with permanent atrial fibrillation. Due to the fast irregular ventricular rate a dilated tachycardiomyopathy can develop and proper rate control can revert these ventricular changes. Rate control can be achieved with beta-blockers, Ca-antagonist and digoxine. | ||
** < | ** <b>Invasive treatment:</b> | ||
<b>His-Ablation with pacemaker implantation: 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. | *** <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. | ||
* <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. Overall rhythm control is difficult and anti-arrhythmic drugs have many (pro-arrhythmic) side effects. 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. Overall rhythm control is difficult and anti-arrhythmic drugs have many (pro-arrhythmic) side effects. Therefore prescription of these drugs should occur with caution. | ||
Invasive treatment: | ** <b>Invasive treatment:</b> | ||
Medical therapy is not always sufficient to maintain | Medical therapy is not always sufficient to maintain | ||
Catheter ablation: | *** <b>Catheter ablation:</b> | ||
Surgical treatment | *** </b>Surgical treatment</b> | ||
Anticoagluation treatment | * </b>Anticoagluation treatment</b> | ||
==AV node arrhythmias== | ==AV node arrhythmias== | ||