UECps28_X_0MbNA7CEhA2KXFbSV4lgOnyfs0aS4EHLL-UThNgJE79VsNtiX3_P_aTfQ=w1200-h630-p' alt='Algorithms In C Parts 1-5 Pdf' title='Algorithms In C Parts 1-5 Pdf' />ACCAHAESC Guidelines for the Management of Patients With Atrial Fibrillation Executive Summary A Report of the American College of CardiologyAmerican Heart Association Task Force on Practice Guidelines and the European Society of Cardiology CommitteeThe major issues in management of patients with AF are related to the arrhythmia itself and to prevention of thromboembolism. In patients with persistent AF, there are fundamentally 2 ways to manage the dysrhythmia to restore and maintain sinus rhythm or to allow AF to continue and ensure that the ventricular rate is controlled. A. Rhythm Control vs Heart Rate Control. Reasons for restoration and maintenance of sinus rhythm in patients with AF include relief of symptoms, prevention of embolism, and avoidance of cardiomyopathy. B. Cardioversion. Basis for Cardioversion of AFCardioversion is often performed electively to restore sinus rhythm in patients with persistent AF. The need for cardioversion can be immediate, however, when the arrhythmia is the main factor responsible for acute HF, hypotension, or worsening of angina pectoris in a patient with CAD. Nevertheless, cardioversion carries a risk of thromboembolism unless anticoagulation prophylaxis is initiated before the procedure, and this risk appears to be greatest when the arrhythmia has been present more than 4. Methods of Cardioversion. Cardioversion can be achieved by means of drugs or electrical shocks. Drugs were commonly used before electrical cardioversion became a standard procedure. The development of new drugs has increased the popularity of pharmacological cardioversion, although some disadvantages persist, including the risk of drug induced torsade de pointes ventricular tachycardia or other serious arrhythmias. Pharmacological cardioversion is still less effective than electrical cardioversion, but the latter requires conscious sedation or anesthesia, whereas the former does not. The risk of thromboembolism or stroke does not differ between pharmacological and electrical cardioversion. Thus, recommendations for anticoagulation are the same for both methods. C. Pharmacological Cardioversion. Pharmacological cardioversion appears to be most effective when initiated within 7 days after the onset of AF 8. Most such patients have paroxysmal AF, a first documented episode of AF, or an unknown pattern of AF at the time of treatment. Algorithms In C Parts 1-5 Pdf' title='Algorithms In C Parts 1-5 Pdf' />WELCOME TO the Seventh Edition of Introduction to Programming Using Java, a free, online textbook on introductory programming, which uses Java. Engineers rely on an oscilloscope throughout their design cycle, from prototype turnon to production testing. The MSODPO70000 Series oscilloscopes unique. See Section III, Classification. A large proportion of patients with recent onset AF experience spontaneous cardioversion within 2. This is less likely to occur when AF has persisted for more than 7 days. The relative efficacy of various drugs differs for pharmacological cardioversion of AF and atrial flutter, yet many studies of drug therapy for AF have included patients with atrial flutter. The dose, route, and rapidity of administration influence efficacy. Reference is made to the Vaughan Williams classification of antiarrhythmic drugs 9. Table 2. A summary of recommendations is presented in Tables 1. Section IX B, Recommendations for Pharmacological and Electrical Cardioversion of AF, Tables 1. Although clinical use of the antiarrhythmic drugs listed has been approved by regulatory agencies, therapeutic use for AF has not been mentioned or approved in all cases in each country. The recommendations given in this document do not necessarily adhere to governmental regulations and labeling requirements. Table 2. 61. 35. Vaughan Williams Classification of Antiarrhythmic Drug Actions. A frequent issue related to pharmacological cardioversion is whether the antiarrhythmic drug should be started in the hospital or on an outpatient basis. The major concern is the potential for serious adverse effects, including torsade de pointes ventricular tachycardia. With the exception of those involving low dose oral amiodarone 9. D. Electrical Cardioversion. Direct current cardioversion involves an electrical shock synchronized with the intrinsic activity of the heart. This ensures that electrical stimulation does not occur during the vulnerable phase of the cardiac cycle 9. Successful cardioversion of AF depends on the nature of the underlying heart disease and the current density delivered to the atrial myocardium. The latter, in turn, depends on the voltage of the defibrillator capacitor, the output waveform, the size and position of the electrode paddles, and transthoracic impedance. In a randomized controlled study of 3. The energy requirement was lower and overall success was greater with the anterior posterior configuration 8. Cardioversion is performed with the patient having fasted and under adequate anesthesia. Short acting anesthetic agents are preferred, because cardioversion patients are well suited to day care and should recover rapidly after the procedure 9. An initial shock of 1. J is often too low, and an initial energy of 2. J or greater is recommended for electrical cardioversion of AF. Devices that deliver current with a biphasic waveform appear to achieve cardioversion at lower energy levels than those that use a monophasic waveform. The primary success rate as measured 3 days after cardioversion in 1. Only 2. 3 of the patients remained in sinus rhythm after 1 year and 1. For patients who relapsed again, a third cardioversion resulted in sinus rhythm in 5. Thus, sinus rhythm can be restored in a substantial proportion of patients by direct current cardioversion, but the rate of relapse is high unless antiarrhythmic drug therapy is given concomitantly. Cardioversion of patients with implanted pacemaker and defibrillator devices is safe when appropriate precautions are taken. The device should be interrogated immediately before and after cardioversion to verify appropriate function. The paddles used for external cardioversion should be positioned as distant as possible from the device, preferably in the anterior posterior configuration. The risks of electrical cardioversion are mainly related to embolic events and cardiac arrhythmias. Thromboembolic events have been reported in 1 to 7 of patients who did not receive anticoagulation before cardioversion 1. Descargar Drivers Sonido Para Windows Xp. Various brief arrhythmias might arise, especially ventricular and supraventricular premature beats, bradycardia, and short periods of sinus arrest 1. Ventricular tachycardia and fibrillation can be precipitated in patients with hypokalemia or digitalis intoxication 1. A slow ventricular response to AF in the absence of drugs that slow AV nodal conduction can indicate conduction defect. The patient should be evaluated before cardioversion with these issues in mind to avoid symptomatic bradycardia 1. Transient ST segment elevation can appear on the ECG after cardioversion 1. MB can rise even without apparent myocardial damage. Prophylactic drug therapy to prevent early recurrence of AF should be considered individually for each patient. Should relapse particularly early relapse occur, antiarrhythmic therapy is recommended in conjunction with the second attempt. Further cardioversion is of limited value. In highly symptomatic patients, infrequently repeated cardioversion can be an acceptable approach. E. Maintenance of Sinus Rhythm. Pharmacological Therapy to Prevent Recurrence of AFMaintenance of sinus rhythm is relevant in patients with paroxysmal AF in whom episodes terminate spontaneously and persistent AF in whom electrical or pharmacological cardioversion is necessary to restore sinus rhythm.