Atrial fibrillation
Last reviewed: 23.04.2024
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At present, brady- and tahisystolic forms of atrial fibrillation are distinguished. Due to the lesser influence on hemodynamics, the bradysystolic form of atrial fibrillation has a more favorable course. Clinically, the tachysystolic form can manifest itself as a right- and left ventricular failure. On the electrocardiogram, the intervals RR are different, there are no teeth P.
Treatment of atrial fibrillation
The drug of choice for tahisistolicheskoy form of atrial fibrillation, especially complicated heart failure, is digoxin. With its appointment, side effects may occur: bowel ischemia, atrioventricular block, non-paroxysmal nodular tachycardia, ventricular arrhythmias. In this regard, digoxin is not used in cases of atrioventricular blockade, hypertrophic cardiomyopathy, severe hypokalemia and / or hypomagnesemia, sinus node weakness syndrome, WPW syndrome. The drug is ineffective in multifocus atrial tachycardia.
If digoxin can not be used to stop an attack of atrial fibrillation, it is advisable to start treatment with a slow (5-10 min) intravenous injection of 0.25% solution of verapamil from 0.1-0.15 mg / kg. If verapamil does not lead to restoration of the sinus rhythm, then a decrease in the frequency of ventricular contraction due to retardation of atrioventricular conduction helps to improve the condition of patients.
In adolescents, it is possible to use a 2.5% Aimalin solution (antiarrhythmic drug IA class) at a rate of 1 mg / kg, which to a lesser extent causes a decrease in blood pressure. It is used in WPW syndrome, but its effect with atrial fibrillation is short. In addition, you can use a 10% solution of procainamide from the calculation of 0.15-0.2 ml / kg intravenously, nitroglycerin under the tongue. To restore the sinus rhythm in hospital conditions, it is possible to use quinidine (up to 18 μg / kg per day) or disopyramide for 0.1-0.2 g after 6 hours.
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