Atrial fibrillation: preventing the risk of stroke

What is the treatment of atrial fibrillation?

There are many ways to manage atrial fibrillation, and each, from anticoagulants to defibrillators to ablative surgery, have their place in the management of this disease. One of the best way is using the Eliquis generic medication.
If a cause has been identified, the treatment of it, when it is possible, is often the simplest way to treat AF definitively: treatment of hyperthyroidism, valvular surgery …
In the absence of a cause curable, the treatment of atrial fibrillation has been the subject of many recommendations. The medical treatment is based on several principles:
• Reduction of atrial fibrillation (with drugs or “cardioversion”), that is to say, get back to a normal heart rhythm (rhythm “sinus rhythm”)
• Reduce the risk of recurrence of AF,
• Slow heart rate to allow better tolerance, in case of failure or contraindication to reduction,
• Prevention of complications, especially embolic (stroke).

How to reduce atrial fibrillation?

 

The reduction of atrial fibrillation can be achieved by the administration of anti-arrhythmic drugs, of the amiodarone or flecainide type, orally or intravenously. In some cases, this reduction can be made by the patient himself outpatient (without hospitalization), by taking a single oral dose of an anti-arrhythmic at the onset of symptoms. In case of atrial fibrillation of less than 48 hours, the reduction of AF by external electric shock (cardioversion) can be attempted from the outset without any particular precaution. If the start date is unknown or older, it must be preceded by an effective anticoagulant treatment for at least 3 weeks, or after transesophageal echocardiography to check the absence of thrombus formed in the atria. The electrical reduction (defibrillation) is performed under brief general anesthesia, by delivering a short-lived electric shock to the patient’s chest. Cardioversion is all the more cost-effective from the medical point of view that fibrillation is recent. The risk of recurrence in the short term of AF seems all the more limited as the fibrillation state was very short and controlled from the outset, there has been no previous repeated attempts and unsuccessful reduction and, of course, that there is no notion of an already old pathological heart condition. A short-lived electric shock at the patient’s chest. Cardioversion is all the more cost-effective from the medical point of view that fibrillation is recent. The risk of recurrence in the short term of AF seems all the more limited as the fibrillation state was very short and controlled from the outset, there has been no previous repeated attempts and unsuccessful reduction and, of course, that there is no notion of an already old pathological heart condition. A short-lived electric shock at the patient’s chest. Cardioversion is all the more cost-effective from the medical point of view that fibrillation is recent. The risk of recurrence in the short term of AF seems all the more limited as the fibrillation state was very short and controlled from the outset, there has been no previous repeated attempts and unsuccessful reduction and, of course, that there is no notion of an already old pathological heart condition.

How to reduce the risk of recurrence of atrial fibrillation?

After reduction, the maintenance of the heart in sinus rhythm is obtained by the prescription of anti-arrhythmic drugs orally (examples of usable molecules: amiodarone, sotalol (beta-blocking membrane stabilizing effect), flecainide and quinidine). The recidivism rate remains high. The prescription of anti-arrhythmic drug therapy is not mandatory if it is a first attack, rapid resolution, with a correct tolerance and the absence of underlying heart disease.

What to do in case of failure of the reduction of atrial fibrillation?

When reduction attempts have failed or there is a contraindication to the reduction, one will simply slow down the heart rate to avoid disabling symptoms and poor cardiac tolerance. The goal is to maintain the resting heart rate at less than 80 beats per minute or to get close to it. In the case of heart failure, an aggressive attitude aimed at reducing fibrillation and maintaining sinus rhythm by medical means does not seem to be superior in terms of complications and changes over time in the light of an attitude that merely slows down and control the heart rate.

Drugs such as beta-blockers, calcium channel blockers (diltiazem and verapamil), as well as digoxin, and amiodarone may be used.

Another strategy is the use of a defibrillator that emits a controlled electric shock into the heart, and turns atrial fibrillation into a normal rhythm. The electronic defibrillator looks like a pacemaker. It is equipped with one or more probes and a battery and measures only a few centimeters. The casing is placed under anesthesia in a pocket under the skin of the pectoral region. The electronic circuit continuously monitors the heart rate. In the event of tachycardia or ventricular fibrillation, it is started by applying, as needed, discharges ranging from 5 volts to a defibrillation shock of up to 500 volts .The device thus controls not only arrhythmias, but can also remedy, if necessary, cardiac arrest. The device works for 4 to 5 years. The case change is a small surgery requiring at least one day hospitalization and local anesthesia.

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