A systematic review of the literature on…
Radio Frequency Cardiac Ablation Therapy as First Line Treatment for Paroxysmal Atrial Fibrillation vs. Anti-Arrhythmic Drug Therapy.
The Capstone Project
Presented to
The Faculty of the Division of Physician Assistant Studies
Long Island University
In Partial Fulfillment of the Requirements for the Master of Science Degree in Physician Assistant Studies
By
Boris David Fuzaylov
07/06/2015
Introduction Atrial fibrillation (AF) is the most common sustained heart rhythm disturbance in the United States, affecting over 2 million individuals with over 150,000 new cases of AF being diagnosed each year. Approximately 4% of the population over the age of 65 is affected. As a person ages,
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A website for the American Heart Association (AHA) and the American College of Cardiology Foundation showed guidelines as to how to treat all classifications of atrial fibrillation. This article mentioned recommendations for which procedure/treatment was appropriate for each classification of AF and if the benefit was greater than the risk. Another search was done and was geared towards certain medical websites such as the Journal of the American Medical Association (JAMA), and the New England Journal of Medicine (NEJM), which prompted a search for the topic that led to the discovery of a few articles that are presented in this paper. The last tool that was used was Long Island University’s library online database that is available to all students to help locate articles when working on a research paper. The databases that were primarily used were Medline: PubMed and Medline: Ebsco created by the National Library of Medicine and it was found to be quite helpful in finding copious articles relevant to the topic. In the search bar, keywords such as: “atrial fibrillation”, “catheter ablation”, and “paroxysmal”, were used which resulted in many articles. The filters were set to human subjects, the English language, full text articles, and articles published since 2005. Results that did not include atrial …show more content…
Most focal AF is initiated by premature beats from the orifices of the pulmonary veins or from the myocardial sleeves inside the PV’s, and radio frequency catheter ablation of triggered foci has been shown to cure AF. 14 Experts in catheter ablation have acknowledged that pulmonary vein isolation is the primary approach for patients with AF. It has been noted that pulmonary vein ostial ablation may result in pulmonary vein stenosis, which is why most conductors have discussed going away from the ostium and towards the antrum of the pulmonary vein.14 The antrum blends into the posterior wall of the left atrium and to be able to include most of the pulmonary vein, ablation must be performed around the entire antrum along the posterior left atrium wall.14 A recent meta analysis of 31 studies including 2,800 patients found that the single procedure success rate of pulmonary vein isolation of all types of AF without anti arrhythmic drugs was 57%.14 An analysis of 34 studies enrolling a total of 3,481 patients show that the success rate without anti arrhythmic drugs increased to 71% after multiple procedures.14 However, examining data from 6 pioneering centers with greater experience in AF ablation, the success rate without anti arrhythmic drugs was 81% in 1,039 patients followed up for a period of 6 months to 2.4 years.14 Recently, two 5 year follow up studies reported that single procedure success rates without
What treatment might you expect the health care provider to initially order for S.D.’s atrial fibrillation?
This case study discusses the management of a 68 year old male who presented with chest palpitations secondary to rapid atrial fibrillation. Atrial fibrillation is a common cardiac arrhythmia with serious complications if not treated correctly. This essay will discuss the initial clinical presentation of the patient and examine the management and outcome of the interventions applied. The significance of atrial fibrillation including its pathophysiology and aetiology will also be discussed.
43 percent of alarm conditions indicated non-critical, and “generally non-actionable,” events; 38 percent of alarm conditions indicated premature ventricular complexes (PVCs), which, since a landmark 1988 Cardiac Arrhythmic Suppression Trial (CAST) study, are no longer treated; and 3.6 percent of alarm
Cardiac dysrhythmias come in different degrees of severity. There are heart conditions that you are able to live with and manage on a daily basis and those that require immediate attention. Atrial Fibrillation is one of the more frequently seen types of dysrhythmias (NIH, 2011). The best way to diagnosis a heart condition is by reading a cardiac strip (Ignatavicius &Workman, 2013). Cardiac strips play an chief part in the nursing world allowing the nurse and other trained medical professionals to interpret what the heart is doing. In a normal strip, one can clearly identify a P wave before every QRS complex, which is then followed by a T wave; in Atrial Fibrillation, the Sinoatrial node fires irregularly causing there to be no clear P
Atrial fibrillation (AF) is the commonest arrhythmia. It is characterised by disorganised random electrical activity in the atria that results in a lack of effective atrial contraction. It is associate with a five-fold risk of stroke and a three-fold incidence of congestive heart failure, and overall higher mortality. There are many known risk factors for the development of acute AF including coronary artery disease (CAD), hypertension and valvular heart disease but AF may occur in the absence of any underlying cardiac or non-cardiac disease . As its incidence increases with age and with the ageing of western populations it is becoming ever more common in surgical patients.
Atrial fibrillation is a common disorder associated with significant morbidity, mortality, and economic costs. Radio-frequency catheter ablation (RFCA) of the distal pulmonary veins and posterior left atrium is increasingly being used by cardiac interventional electrophysiologists to treat patients with atrial fibrillation. The success of RFCA is highly dependent on a preprocedural understanding of the complex three-dimensional (3D) anatomy of the distal pulmonary veins and posterior left atrium. Neither fluoroscopy nor echocardiography can adequately depict this anatomy.
On average a healthy adult during state of rest has a heart rate of 80 beats per minute, that’s 4,800 times per hour, 115,200 times per day, and over the course of a year about 42,048,000 times. Each beat has the important job of pumping blood and keeping you alive. Every so often the extraordinary complexity of the human body has its flaws, for some heart rates are not always steady but rather rapid with erratic electrical pulses. An example of a dangerous flaw that could occur within the human body is Ventricular Fibrillation. Ventricular Fibrillation is the name given to the condition when the pumping chambers in your heart quiver uselessly instead of pumping blood which causes cardiac arrest.
This patient has experienced an inferior wall STEMI, which has led to post-infarction conduction abnormalities. It is important to focus on the anatomy of the coronary vessels, the corresponding walls they supply, and the corresponding conducting nodes supplied. Also, one must know what walls of the heart correspond to what leads on the ECG. Inferior wall corresponds to leads II, III, and AVF. The inferior wall is predominantly supplied with blood by the right coronary artery (RCA). Other important structures that are supported predominantly by the RCA include the right ventricle and the AV node. A third-degree (or complete) heart block is the most likely tracing one would expect to see in a patient with hemodynamic instability. Management at this point, as per ACLS guidelines, starts with an initial dose of 0.5 mg of atropine IV push, repeating every 3–-5 minutes for a maximum of 3 mg if necessary. If this is ineffective, then one then must consider transcutaneous pacing. This patient had an inferior MI status post PCI bare metal stent placement into the RCA. She then moves acutely into irregular bradycardia with hemodynamic instability. The most likely post-conduction abnormality that would fit this scenario would be a third-degree AV block, which warrants a pacemaker placement after stabilization per ACLS
Cardiovascular arrhythmias are common among both males and females and over a wide age range. As a former cardiac nurse, I know firsthand how often people develop new and reoccurring irregular rhythms. These patients would be ordered a cardiac monitoring device, such as the ones that were mentioned above. However, without access to advanced technology systems such as ZywiePro, there is a risk for adverse outcomes for both the providers and the patients. For example, the patient with a standard telemetry monitoring system would have to turn in the device, wait for the results to be read, and then return to the office to discuss the results and management options. This becomes time consuming, costly, and inconvenient to both the provider and the patient. In addition, it delays treatment. I believe with the evolving healthcare demands and increasing shortage of providers, we need to take advantage of the technology that has been designed to meet our healthcare needs. ZywiePro has been designed to do just that. It offers immediate diagnostic results that makes communicating and treating patients more
On a yearly basis in the United States, Mostafa, EL-Haddad, Shenoy, and Tuliani (2012) stated that approximately 640,000 patients end up having coronary artery bypass graft (CABG) and between 5% and 40% of these patients end up developing atrial fibrillation (AFib). This can be prevented if precautionary measurements are taken. As an intensive care unit (ICU) nurse, I have witnessed an influx of patients who developed AFib following open heart surgery in the recent year and wanted to research the problem. Thus, my database project for early detection and implementing preventive measures to decrease the prevalence of AFib following open heart surgery. With the help of my clinical educator, I was able to conduct chart reviews. The results showed
While catheter ablation to terminate ventricular tachycardia (VT) due to myocardial infarction (MI) has been shown to be a promising therapy, the technique’s 30\% failure rate in treating patients has prevented the widespread adoption of the procedure. Recent studies have speculated that the high failure rate could be due to the inadequacy of point-by-point endocardial mapping techniques to detect the complex 3D reentrant pathways arising from the infarct at a sufficiently high resolution. There is an urgent need for new methodologies that can accurately identify post-infarction reentrant sites thereby improving ablation targeting and the efficacy of the therapy.
As technology develops nothing can hold it back from intertwining with different aspects of life. One of those aspects is the heart. In the nineteenth century Wilson Greatbatch invented the first pacemaker with long life lithium batteries (“Pacemaker”). A pacemaker “uses electrical impulses to regulate the beating of the heart. They treat disorders making the heart’s rhythm too slow, fast or irregular” (“Pacemaker”). Since then technology has evolved the implantation of the pacemaker. Recently, Dr. Chris Ellis, director of clinical arrhythmia research at Vanderbilt University’s Heart and Vascular Institutue, implanted the Micra TPS, a pacemaker that is the size of a vitamin pill, into fifty nine year old Joseph Nelson. The Micra TPS is revolutionary
Artificial Cardiac Pacing (ACP) is an effective treatment for patients suffering from bradycardia. Atrio-ventricular block (AVB) is a common cause of bradycardia indicating the need for the implantation of a permanent pacemaker (PM). Roughly 3000 pacemaker devices are being implanted in Israel annually, more than half of them due to AVB block. A possible complication of this treatment for patients with AVB is the development of heart failure secondary to prolonged pacing via the right ventricle with a normal baseline heart function (Right Ventricular Pacing Induced Cardiomyopathy; RV-PICM).
Oral anticoagulants should only be prescribed to patients who suffer from supraventricular arrhythmias and heart failure. Also in patients showing signs of right-sided heart failure diuretics should be used to prevent fluid retention. The treatment of arrhythmias does not differ significantly –
However, the following revisions on parameter adjustments are recommended to improve the paper. All patients initially received 130-Hz, 91-µs pulse, and 4-mA (mA) current during the initial active