天津医科大学内科学课件 Cardiac Arrhythmias.pptVIP

Atrial Fibrillation MANAGEMENT (4) The combined use of digitalis and a beta blocker or calcium antagonist can be helpful in slowing the ventricular rate. Digitalis may be more effective if associated LV dysfunction is present; without such dysfunction, a beta blocker may be preferable to control the ventricular rate. * Atrial Fibrillation MANAGEMENT(5) Class IA, IC,and III (amiodarone, sotalol) agents can be used to terminate acute-onset atrial fibrillation and prevent recurrences of atrial fibrillation. * Atrial Fibrillation Other Treatments In some with frequent recurrence and rapid ventricular rates not controlled by drugs, Other Treatments include: AV node modification. Interruption by radiofrequency catheter ablation Implantation of a rate-adaptive VVI (VVIR) pacemaker. atrial or dual-chamber pacing. Surgical application of the Maze procedure, the atrial compartment operation. * Atrial Tachycardias ECG RECOGNITION atrial rate 150 to 200 beats/min. The P wave contour is different from that of the sinus P wave. As the atrial rate increases and AV conduction becomes impaired, a Wenckebach (Mobitz type I) second-degree AV block can ensue. This aberration is sometimes called atrial tachycardia with block. * FIGURE A–11. Atrial tachycardia. This 12-lead electrocardiogram and rhythm strip (bottom) demonstrate an atrial tachycardia at a cycle length of approximately 520 milliseconds. Conduction varies between 3:2 and 2:1. Note the negative P waves in leads II, III, and aVf and, when consecutive P waves are conducted, that the RP interval exceeds the PR interval. * Atrial Tachycardias CLINICAL FEATURES Atrial tachycardia occurs most commonly in patients with significant structural heart disease such as coronary artery disease, with or without myocardial infarction, cor pulmonale, or digitalis intoxication, It is also seen in patients without structural heart disease. Potassium depletion can precipitate the arrhythmia in patients