心脏转移与除与"节奏和除"对于老年患者持续性心房动的治疗
William Eysenck1, Neil Sulke1, Nikhil Patel1
1Consultant Cardiologist.
The British journal of cardiology
|November 18, 2024
概括
使用阿米奥达龙进行心房动 (AF) 切除显示,与使用阿米奥达龙进行12个月的直流心脏转换 (DCCV) 相比,老年人患心房动的负担较低. 所有治疗都改善了症状和运动能力,DCCV在不到一半的患者中恢复了鼻节律.
科学领域:
- 心脏病学 心脏病学
- 电子生理学 电子生理学
- 老年病的医生 老年病的医生
背景情况:
- 持久性心房动 (AF) 显著影响老年人的生活质量和运动能力.
- 65岁及以上患者持续性AF的当前治疗选择包括AF切除,心房结节切除 (AVNA) 的永久起器 (PPM) 和直流心脏转变 (DCCV).
研究的目的:
- 为了比较AF切除,PPM与AVNA和DCCV治疗65岁及以上患者持续性AF的疗效.
- 为了评估这些干预后的AF复发,症状负担和心肺功能.
主要方法:
- 77名患有持续性AF的患者被随机分配到AF切除+阿米奥达龙,PPM与AVNA,或DCCV+阿米奥达龙.
- 主要终点是持续的AF复发,通过植入式监视器或PPM在12个月内检测到.
- 用心肺运动测试 (CPET) 和症状问卷来评估结果.
主要成果:
- 与DCCV+amiodarone相比,12个月的AF剥离+阿米奥达龙显示了较低的AF负担 (17.0%对61.7%,p<0.0001).
- 与DCCV (28%对60%,HR 0.559) 相比,有一个非显著的趋势是减少AF复发与切除.
- 所有治疗组都表现出改进的欧洲心律协会 (mEHRA) 症状得分和 sinus 节律恢复的 VO2 峰值增加.
结论:
- 在患有持续性AF的老年患者中,与阿米奥达龙结合的AF切除导致与阿米奥达龙的DCCV相比,AF负担减少.
- 虽然在统计学上不显著,但AF消去显示出较低复发率的趋势.
- 所有评估的疗法都改善了患者的症状和运动能力,尽管DCCV在不到50%的患者中恢复了鼻节律.
相关概念视频
Disturbances in Heart Rhythm
908
Arrhythmia or dysrhythmia refers to an abnormal heart rhythm caused by a defect in the heart's conduction system. It can cause the heart to beat irregularly, too quickly, or too slowly, leading to symptoms like chest pain, shortness of breath, and fainting. Factors such as stress, caffeine, alcohol, nicotine, cocaine, certain drugs, congenital defects, diseases, and electrolyte abnormalities can trigger arrhythmias.
Arrhythmias are categorized by their speed, rhythm, and origin. A slow...
Arrhythmias are categorized by their speed, rhythm, and origin. A slow...
908
Antiarrhythmic Drugs: Class IV Agents as Calcium Channel Blockers
782
Class IV antiarrhythmic drugs, such as verapamil and diltiazem, block calcium channels. They primarily affect the heart, slowing the conduction in calcium-dependent tissues like the SA and AV nodes. These drugs manage reentrant supraventricular tachycardia (SVT) and reduce ventricular rate in atrial flutter/fibrillation.
Verapamil, a calcium channel blocker, inhibits calcium movement across myocardial cell membranes and vascular smooth muscle. This results in the dilation of coronary and...
Verapamil, a calcium channel blocker, inhibits calcium movement across myocardial cell membranes and vascular smooth muscle. This results in the dilation of coronary and...
782
Antiarrhythmic Drugs: Class III Agents as Potassium Channel Blockers
911
Class III antiarrhythmic drugs are a group of medications that can prolong action potentials in the heart. They achieve this by blocking potassium channels or enhancing inward currents from sodium channels. However, these drugs have a unique property of "reverse use-dependence," which is most pronounced at slower heart rates and can lead to torsades de pointes—a specific type of arrhythmia. However, it is essential to note that excessive QT interval prolongation—a measure of...
911
Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers
707
Adrenergic stimulation generally impacts cardiac rate and rhythm. Specifically, stimulation of the β-adrenoceptors triggers an increase in intracellular calcium ion influx and pacemaker currents, which may cause arrhythmias. Catecholamines like adrenaline also demonstrate β2-adrenoceptor-mediated hypokalemia, impacting cardiac action potential and disrupting the normal cardiac rhythm. Class II antiarrhythmic drugs are β-adrenoceptor antagonists or β-blockers, which...
707
Mechanism of Cardiac Arrhythmias
891
Arrhythmias are irregular heart rhythms occurring when the heart's electrical impulses become abnormal. These disturbances can lead to various symptoms, depending on their severity and the underlying cause. Some common factors contributing to arrhythmias include hypoxia, ischemia, electrolyte imbalances, excessive catecholamine exposure, drug toxicity, and muscle overstretching. Arrhythmias can be classified into two main types based on the rate and site of origin of abnormal heart rhythms.
891
Antiarrhythmic Drugs: Class I Agents as Sodium Channel Blockers
1.2K
Class I antiarrhythmic drugs are used to treat various types of arrhythmias or irregular heart rhythms. These drugs block the sodium (Na+) channels in the cardiac cells, thereby affecting the movement of electrical impulses across the heart. Class I antiarrhythmic drugs are divided into three subgroups: Class IA, Class IB, and Class IC, each with distinct mechanisms of action and effects on the heart.
Class 1A Antiarrhythmic Drugs: These drugs work by moderately blocking sodium channels,...
Class 1A Antiarrhythmic Drugs: These drugs work by moderately blocking sodium channels,...
1.2K


