Atrial fibrillation

Currently, a distinction is made between brady- and tachystolic forms of atrial fibrillation. Due to its lesser effect on hemodynamics, the bradystolic form of atrial fibrillation has a more favorable course. Clinically, the tachystolic form can manifest itself as right- and left-ventricular failure. On the electrocardiogram, the RR intervals are different, and there are no P waves.

Treatment of atrial fibrillation

The drug of choice for tachystolic atrial fibrillation, especially complicated by heart failure, is digoxin. Its administration may cause side effects: intestinal ischemia, atrioventricular block, non-paroxysmal nodal tachycardia, ventricular arrhythmias. In this regard, digoxin is not used for atrioventricular block, hypertrophic cardiomyopathy, severe hypokalemia and/or hypomagnesemia, sick sinus syndrome, WPW syndrome. The drug is ineffective for multifocal atrial tachycardia.

If it is impossible to use digoxin to stop an attack of atrial fibrillation, it is advisable to begin treatment with a slow (5-10 min) intravenous administration of a 0.25% solution of verapamil at a rate of 0.1-0.15 mg/kg. If verapamil does not restore sinus rhythm, then a decrease in the ventricular rate due to a slowing of atrioventricular conduction helps improve the condition of patients.

In adolescents, it is possible to use a 2.5% solution of ajmaline (an antiarrhythmic drug of class IA) at a rate of 1 mg/kg, which causes a decrease in blood pressure to a lesser extent. It is used in WPW syndrome, but its effect on atrial fibrillation is short-lived. In addition, it is possible to use a 10% solution of procainamide at a rate of 0.15-0.2 ml/kg intravenously, nitroglycerin sublingually. To restore sinus rhythm in a hospital setting, quinidine (up to 18 mcg/kg per day) or disopyramide at 0.1-0.2 g every 6 hours can be used.

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