Tag Archives: cardioversion

Drug therapies include anticoagulants to reduce the risk of stroke and anti-arrhythmics to restore/maintain the normal heart rhythm or slow the heart rate in patients who remain in AF. Non-pharmacological management options include electrical cardioversion, which may be used to ‘shock’ the heart back to its normal rhythm. The high risk of stroke associated with electrical cardioversion can be reduced by oral anticoagulation. Although effective in reducing the risk of thromboembolism, the limitations of warfarin present considerable challenges for its use in clinical practice. The challenges of maintaining warfarin within an appropriate th

Understanding the mechanisms of AF lies at the heart of its treatment. AF occurs when structural and/or electrophysiological abnormalities alter atrial tissue to promote abnormal impulse formation and/or propagation (figure 1).3 Multiple clinical risk factors, electrocardiographic/echocardiographic features and biochemical markers are associated with an increased risk of AF (table 1), and, AF can be described in terms of the duration of episodes using a simplified scheme (table 2).3 Figure 1. Mechanisms of atrial fibrillation Table 1. Risk factors3 The aim of treatment is to prevent stroke and alleviate symptoms.4 Drug therapies include antic

X-VERT: rivaroxaban▼ an alternative to VKA in cardioversion for AF Watch Professor Keith Fox, Chairman of the ESC programme committee discussing the relevance of X-VERT and other studies for UK practice in our podcast from the ESC Oral anticoagulant therapy with rivaroxaban is an alternative to vitamin K antagonists (VKAs) in patients with AF who are undergoing elective cardioversion according to the results of the X-VERT study.1 In addition, rivaroxaban may potentially have one important advantage over VKAs, with a shorter time to cardioversion, the study suggests. Professor Riccardo Cappato (University of Milan, Italy), the co-principal

Case report Figure 1. The extracorporeal membrane oxygenation (ECMO) system A 20-year-old female student under investigation for syncopal attacks was found to have a normal electrocardiogram (ECG) and cardiac morphology on echocardiography. She then suffered ventricular fibrillation at rest while talking to friends. They performed cardiac massage and a paramedic ambulance arrived within four minutes. Defibrillation was attempted using anterior and lateral electrodes. When this was unsuccessful, she was intubated and a Lucas cardiac compression device applied, even though the Accident and Emergency (A&E) department was less than one mile a

Temporary pacing lead insertion in Lanarkshire hospitals between 2005 – 2007 Dear Sirs, The retrospective study recently reported by Yassin et al. (Br J Cardiol 2010;17:34-5) has some potential confounding factors not reported by the authors. In addition, there is a complete absence of data from their questionnaires, with any appropriate analysis. The study looks at procedures performed between 2005 and 2007. During this timeframe the numbers of doctors in training were being reduced and doctors in more junior grades did not always possess the same procedural experience as would have been previously expected, related to the impact of f

It may be that these figures are actually very good compared with data from other centres, given that this service was designed specifically to reduce the delay in receiving DCCV. It would be interesting, therefore, to have more data on the types of patients receiving cardioversion, and whether there are any factors that may predict both initial and long-term success. It is clear, for example, from other data that the current National Institute for Health and Clinical Excellence (NICE) recommendations to utilise cardioversion for patients with heart failure need revising.1 Patient selection If we look at the results in some detail it is clear

The evidence The utility of cardioversion was originally explored in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study,2 which recruited over 4,000 patients aged 65 and over with atrial fibrillation and one additional risk factor for stroke. Patients were randomised to either rhythm control, using electrical cardioversion and medication as necessary, or to rate control using drugs, such as beta blockers or digoxin. To the surprise of the investigators the primary outcome, mortality, was worse in the rhythm control group, as were secondary outcomes such as hospitalisation and serious arrhythmias. Importantly,

No content available