The energy emitting probe ( electrode ) is placed into the heart through a catheter inserted into veins in the groin or neck.It is reasonable to perform repeated cardioversions in patients with persistent AF, provided that sinus rhythm can be maintained for a clinically meaningful period between cardioversion procedures.Prescribed courses of treatment in accordance with these recommendations are effective only if followed.Comparative Effectiveness Review No. 123. (Prepared by the Duke Evidence-based Practice Center under Contract No. 290-2007-10066-I.) AHRQ Publication No. 13-EHC113-EF.The American College of Cardiology (ACC) and the American Heart Association (AHA) have jointly engaged in the production of guidelines in the area of cardiovascular disease since 1980.
Future strategies for reversing the growing epidemic of AF will come from basic science and genetic, epidemiological, and clinical studies.As a result, in response to pilot projects, several changes to this guideline will be apparent, including limited narrative text, a focus on summary and evidence tables (with references linked to abstracts in PubMed), and more liberal use of summary recommendation tables (with references that support the LOE) to serve as a quick reference.OpenUrl FREE Full Text 98. Siu C.W., Lau C.P., Lee W.L., et al. ( 2009 ) Intravenous diltiazem is superior to intravenous amiodarone or digoxin for achieving ventricular rate control in patients with acute uncomplicated atrial fibrillation.
OpenUrl PubMed 185. Feld G.K., Fleck R.P., Fujimura O., et al. ( 1994 ) Control of rapid ventricular response by radiofrequency catheter modification of the atrioventricular node in patients with medically refractory atrial fibrillation.AV node ablation should not be performed without a pharmacological trial to achieve ventricular rate control. (Level of Evidence: C) 2.Oral amiodarone may be useful for ventricular rate control when other measures are unsuccessful or contraindicated. (Level of Evidence: C) Class III: Harm 1.
Other energy sources include laser, cryothermy and high intensity ultrasound.
The American Heart Association explains how to prevent a stroke,.Schneider M.P., Hua T.A., Bohm M., et al. ( 2010 ) Prevention of atrial fibrillation by renin-angiotensin system inhibition: a meta-analysis.The reader is encouraged to consult the full-text guideline (4) for additional guidance and details about atrial fibrillation (AF), because the executive summary contains mainly the recommendations. Jeffrey L.
Hohnloser S.H., Duray G.Z., Baber U., et al. ( 2007 ) Prevention of stroke in patients with atrial fibrillation: current strategies and future directions.Benussi S, Kotecha D, et al. 2016 ESC guidelines for the management of atrial fibrillation developed.Left atrial appendage occlusion is an experimental alternative to anticoagulants.
OpenUrl CrossRef PubMed 46. Frost L., Vestergaard P. ( 2004 ) Alcohol and risk of atrial fibrillation or flutter: a cohort study.Prompt direct-current cardioversion is recommended for patients with AF, Wolff-Parkinson-White syndrome, and rapid ventricular response who are hemodynamically compromised (175). (Level of Evidence: C) 2.
OpenUrl FREE Full Text 112. Jaber W.A., Prior D.L., Thamilarasan M., et al. ( 2000 ) Efficacy of anticoagulation in resolving left atrial and left atrial appendage thrombi: a transesophageal echocardiographic study.
Before consideration of AF catheter ablation, assessment of the procedural risks and outcomes relevant to the individual patient is recommended. (Level of Evidence: C) Class IIa 1.The main risk of cardioversion is systemic embolization of a thrombus (blood clot) from the previously fibrillating left atrium.Nondihydropyridine calcium channel antagonists should not be used in patients with decompensated HF as these may lead to further hemodynamic compromise. (Level of Evidence: C) 3.Vardas President Elect of the ESC, Prof of CardiologyProf. of Cardiology,.