Abstract
Two pharmacological approaches are established in the treatment of atrial fibrillation (AF): 'rhythm control' – usage of antiarrhythmic agents, in order to restore and maintain normal sinus rhythm (NSR); and 'rate control' – usage of agents that prolong cardiac atrioventricular conduction, in order to alleviate clinical symptoms. A retrospective study was conducted, aiming to determine outcome of pharmacological treatment of patients with AF in the emergency room (ER). Discharge Letters of all patients admitted to the ER and subsequently diagnosed with AF over a 1-year period were reviewed (May 2001–May 2002). Data on symptoms duration, drugs administered and outcome of treatment were analysed. In a 1-year period, AF was registered in 242 patients, which represented 4% of total medical emergency admissions (n = 6142). In patients with AF, 64% (n = 152) had paroxysmal AF, 12% (n = 29) had persistent AF, and 24% (n = 58) had permanent AF. In a group of patients with paroxysmal AF, pharmacological conversion into NSR was attempted in 74% of patients (n = 113). 'Rhythm control' was achieved in 50% (n = 56) of patients, 'rate control' in 12% (n = 14) and 38% (n = 43) of patients required prolonged hospital treatment. The anti-arrhythmic drug of choice was propafenon, with conversion attempted in 62% of patients (n = 71) and control achieved in 61% (n = 43), and amiodarone, with conversion attempted in 7% of patients (n = 8), and rhythm control achieved in 50% patients (n = 4). In a group of patients with permanent AF (n = 58), pharmacological treatment was attempted in 69% of patients (n = 40). 'Rate control' was achieved in 50% (n = 20) patients, whereas the others required prolonged hospital treatment. The pharmacological drug of choice was a combination of verapamil and digoxine, with 81% success rate. AF is the most common cardiac arrthymia presented in the emergency room. The 'rhythm control' approach still represents the main target in the treatment of patients with AF presented in the emergency room, whereas 'rate control' is attempted in patients with persistent and permanent AF. In the study, the drug of choice for pharmacological conversion of AF into NSR is propafenon, and for 'rate control' the best results are obtained by administering the combination of verapamil and digoxine.
Highlights
Activation of the HPA axis occurs in order to control potentially deleterious effects of systemic inflammation during sepsis
A recent study showed that vascular endothelial damage was the primary cause of multiple organ failure (MOF) in patients with thrombopenia and that humoral mediators played a major role in the development of this process [1]
We aimed to evaluate the relation between the platelet counts (PC), the C-reactive protein and plasma fibrinolytic capacity in intensive care unit (ICU) patients
Summary
Activation of the HPA axis occurs in order to control potentially deleterious effects of systemic inflammation during sepsis. The aim of the study was to evaluate the effects of PEEP on intrathoracic blood volumes and cardiac function measured by the COLD system in ARDS patients. The objective was to identify risk factors and outcome of pregnant women who required intensive care This pilot study aims to find stress (S) and other personality traits (physical symptoms [PS], anger [A]) among the ICU staff, and any existing correlation between them and length of working time (LWT) in the ICU and with educational level (EDL). The role of Drotrecogin alfa (activated) (recombinant human activated protein C [rhAPC]) in modulating microvascular coagulation through the inhibition of thrombin generation has been well studied in experimental and clinical settings of severe sepsis, little is known about its direct anti-inflammatory effects on vascular endothelial cells. The aim is to determine whether an effective lifestyle adaptation program post CABG could enhance the quality of life of the CABG patient
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