• Title/Summary/Keyword: Fibrillation-control

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Effects of Over-drive Pacing on the Suppression of Recurring the Atrial Fibrillation after open Heart Surgery (개심술후 오버드라이브 심방페이싱(Over-drive atrial pacing)의 심방세동발생억제에 대한 연구)

  • 박영환
    • Journal of Chest Surgery
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    • v.24 no.11
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    • pp.1081-1089
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    • 1991
  • Atrial fibrillation is characterized by beat to beat irregularity of shape, size, conduction time and polarity. The mechanism of atrial fibrillation can be explained by so called "Multiple wavelet theory". The adverse effect of atrial fibrillation is the decrease of cardiac output by absence of atrial kick[10 ~ 15%] and the possibility of thrombosis in the left atrium which is dangerous to develop the thromboembolism is increased. The present study was designed to assess the effect of overdrive pacing on the suppression of recurring of atrial fibrillation after open heart surgery and the results were summarized as follows: 1. There were no significant differences of factors between converting patients and non-converting patients to normal sinus rhythm by electric cardioversion after open heart surgery. 2. Among converting patients to normal sinus rhythm, there were no significant differences of factors between study group and control group. 3. Cardiothoracic Ratio on the preoperative chest film was significantly larger in the patients of recurring atrial fibrillation within 72hrs than in the patients of maintaining normal sinus rhythm. [61.7$\pm$ 1.4% vs 67.7$\pm$2.4%, p=0.03] 4. There was a significant difference of suppressive effects between overdrive pacing group and control group among recurred cases until 24, 48, and 72hours [Fisher`s exact test ; p=0.037, p=0.076, p=0.53, respectively] 5. There was a difference of the delay of recurring of atrial fibrillation between study group and control group among recurred cases within 72 hours.[53.4$\pm$6.9hr vs. 19.3$\pm$3.8 hr, p<0.01] We think that the overdrive pacing may suppress the natural pacemaker and the converted normal sinus rhythm is maintained longer than control group during critical immediate postoperative period.ve period.

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Spontaneous Conversion of Atrial Fibrillation to Normal Sinus Rhythm Following Recurrent Cerebral Infarctions

  • Oh, Kyungmi;Choi, Jeong-Yoon;Kim, Byung-Jo
    • Journal of Korean Neurosurgical Society
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    • v.53 no.6
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    • pp.368-370
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    • 2013
  • Post-stroke atrial fibrillation has been frequently reported especially in the patients with right insular infarct as an evidence of cerebrogenic mechanism affecting on cardiac rhythm. However, conversion to normal sinus rhythm after stroke in patients who had atrial fibrillation has not been reported. A 88-year-old men who had untreated atrial fibrillation was admitted to hospital due to left middle cerebral artery territory infarction. During admission, second ischemic attack occurred in right middle cerebral artery territory. At that time, his atrial fibrillation converted spontaneously to normal sinus rhythm. Restored sinus rhythm sustained until he died due to sepsis. This case is evidence supporting a theory that brain is associated with control of cardiac rhythm. If no risk factor is revealed by intensive investigation in patients with acute cerebral infarctions that cardioembolism is strongly suspected as a cause, physicians should concern transformation of atrial fibrillation to normal sinus rhythm after stroke.

Oral Quinidine Therapy for the Maintenance of Sinus Rhythm After Mitral Valve Surgery (승모판 수술후 동율동 유지에 대한 Quinidine의 효과)

  • 윤태진
    • Journal of Chest Surgery
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    • v.26 no.4
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    • pp.249-254
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    • 1993
  • Atrial fibrillation is commonly associated with organic mitral valve disease including rheumatic valvular heart diasease or mitral valve prolapse and so forth. Although spontaneous sinus reversion may occur in some patients after mitral valve operation, recurrence of atrial fibrillation is the rule in most of these patients. We have tried to maintain sinus rhythm after mital valve operation with oral quinidine therapy, and we will show the efficacy of this therapy in this report. From January 1986 to August 1992, 60 patients of mitral valvular heart disease, who had had atrial fibrillation preoperatively and gained sinus rhythm postoperatively, were selected for this study. These patients were divided into 2 groups: Control group [n=30] and Quinidine trial group [n=30]. The age,sex, duration of symptoms,left atrial size and other risk factors of the reversion to atrial fibrillation were adjusted to be similar between the two groups. The maintenance rate of sinus rhythm was calculated by Kaplan-Meier method, and the rate was significantly higher in quinidine trial group than in control group [ p=0.0001 ]. Univariate analysis was performed on the risk factors of reversion to atrial fibrillation, and the difference of maintenance rate between the two groups were corrected with this result: the difference was still statistically significant [ p=0.0205 ]. The quinidine levels were measured in postoperative days, and there were no difference of serum quinidine level between the quinidine success group and quinidine failure group. In conslusion, oral quinidine therapy was effective for the maintenance of sinus rhythm after mitral valve operation compared to control group, and there was no correlation between the serum quinidine level and clinical efficacy of quinidine therpy.

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Development of Surface Modified Tencel Fabrics through the Control of Fibrillation(Part I) -Fibrillation Control Effect through Crosslinking Agent Treatment- (피브릴화 조절을 통한 다양한 감성의 텐셀소재 개발(제1보) -가교체 처리를 통한 피브릴화 조절효과-)

  • 신윤숙;손경희
    • Journal of the Korean Society of Clothing and Textiles
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    • v.25 no.1
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    • pp.144-153
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    • 2001
  • The effect of crosslinking on hand of the cellulase treated Tencel fabrics was investigated. Tencel fabrics were crosslinked with DMDHEU, mechanically prefibrillated, hydrolyzed by cellulase, and treated with softener. The treated fabrics were characterized by add-on, weight loss, DP rating, WRA, strength, SEM analysis and hand measurement. As DMDHEU concentration increased, weight loss of DMDHEU/cellulase treated fabrics decreased. However, cellulase treatment decreased DP properties and strength retention. Less fibrils were observed in the cellulase treated fabrics after DMDHEU treatment than the cellulase treated ones. It was confirmed that crosslinking with DMDHEU treatment was effective to control fibrillation. At 5% of DMDHEU concentration, DMDHEU/cellulase treated fabrics showed softer, smoother and bulkier hand compared with other treated fabrics. Among mechanical properties, bending and shearing properties were decreased progressively through DMDHEU, cellulase, and softener treatment. DMDHEU treatment contributed to impart resilience, cellulase treatment to bulkiness and softener treatment to smoothness. As the treatment of DMDHEU, cellulase, and softener progressed NUMREI, FUKURAMI, and THV increased with the exception of KOSHI.

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Modern Treatment of Atrial Fibrillation

  • Kim, Kyung-Hwan
    • Journal of Chest Surgery
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    • v.47 no.6
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    • pp.499-503
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    • 2014
  • Atrial fibrillation (AF) is the most common type of arrhythmia and has a large global burden. In general, treatment of AF is based on medication and consists of rate and rhythm control together with anticoagulation. However, surgical treatment may be required in patients with AF combined with organic valvular heart diseases or who experience recurrence despite medication. In addition, surgical treatment plays a role in the treatment of lone AF. This article reviews the various surgical treatment options for AF.

Development of Surface Modified Tencel Fabrics through the Control of Fibrillation(Part II) - Fibrillation control effect through reactive dye treatment - (피브릴화 조절을 통한 다양한 감성의 텐셀소재 개발(제2보) -반응성 염료에 의한 피브릴화 조절 효과-)

  • Shin, Younsook;Son, Kyonghee
    • Journal of the Korean Society of Clothing and Textiles
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    • v.25 no.10
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    • pp.1738-1744
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    • 2001
  • 본연구의 목적은 반응성 염료를 이용한 텐셀섬유의 피브릴화 조절 효과를 표면 형태, 감량율, 역학적 성질 및 태의 변화의 측면에서 고찰하는데 있다. 반응성 염료에 의한 가교는 섬유의 비결정 영역의 구조를 변화시켜 피브릴화를 억제하였으며 또한 효소의 작용에 영향을 주어 감량율을 감소시켰다. 반응성 염료에 의한 가교는 역학적 성질 중 특히 전단강성, 압축에너지, 압축레질리언스를 증가시켰다. 염색후 효소처리한 시료는 다른 시료보다 numeri와 fukurami 값이 높아 더 나은 종합태를 보였다. 공정순서에 따라 약간씩 차이가 있는 촉감을 나타냈다.

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Role of Catecholamines in Ventricular Fibrillation (Catecholamines에 관(關)하여 -제4편(第四編) : 심실전동발생(心室顫動發生)에 있어서의 catecholamines의 의의(意義)-)

  • Lee, Woo-Choo
    • The Korean Journal of Pharmacology
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    • v.19 no.1
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    • pp.15-35
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    • 1983
  • Although it has been well known that ventricular fibrillation is the most important complication during hypothermia, much investigation has failed to show the exact nature of the etiology of ventricular fibrillation. Recently, there has been considerable research on the relationship between sympathetic activity and ventricular fibrillation under hypothermia. Cardiac muscle normally contains a certain amount of norepinephrine and the dramatic effect of this catecholamines on the cardiac muscle is well documented. It is, therefore, conceivable that cardiac catecholamines might exert an influence on the susceptibility of heart muscle to tachycardia, ventricular fibrillation and arrhythmia, under hypothermia. Hypothermia itself is stress enough to increase tonus of sympatheticoadrenal system. The normal heart is supplied by an autonomic innervation and is subjected to action of circulating catecholamines which may be released from the heart. If the reaction of the heart associated with a variable amount of cardiac catecholamines is. permitted to occur in the induction of hypothermia, the action of this agent on the heart has not to be differentiated from the direct effects of cooling. The studies presented in this paper were designed to provide further information about the cardio-physiological effects of reduced body temperature, with special reference to the role of catecholamines in ventricular fibrillation. Healthy cats, weighing about 3 kg, were anesthetized with pentobarbital(30 mg/kg) intraperitoneally. The trachea was intubated and the endotracheal tube was connected to a C.F. Palmer type A.C. respirator. Hypothermia was induced by immersing the cat into a ice water tub and the rate of body temperature lowering was $1^{\circ}C$ per 5 to 8 min. Esophageal temperature and ECG (Lead II) were simultaneously monitored. In some cases the blood pH and serum sodium and potassium were estimated before the experiment. After the experiment the animals were killed and the hearts were excised. The catecholamines content of the cardiac muscle was measured by the method of Shore and Olin (1958). The results obtained are summarized as follows. 1) In control animal the heart rate was slowed as the temperature fell and the average pulse rates of eight animals were read 94/min at $31^{\circ}C$, 70/min at $27^{\circ}C$ and 43/min at $23^{\circ}C$ if esophageal temperature. Ventricular fibrillation was occurred with no exception at a mean temperature of $20.3^{\circ}C(21-l9^{\circ}C)$. The electrocardiogram revealed abnormal P waves in each progressive cooling of the heart. there was, ultimately, a marked delay in the P-R interval, QRS complex and Q-T interval. Inversion of the T waves was characteristic of all animals. The catecholamines content of the heart muscle excised immediately after the occurrence of ventricular fibrillation was about thirty percent lower than that of the pre-hypothermic heart, that is, $1.0\;{\mu}g/g$ wet weight compared to the prehypothermic value of $1.41\;{\mu}g/g$ wet weight. The changes of blood pH, serum sodium and potassium concentration were not remarkable. 2) By the adrenergic receptor blocking agent, DCI(2-3 mg/kg), given intramuscularly thirty minutes before hypothermia, ventricular fibrillation did not occur in one of five animals when their body temperature was reduced even to $16^{\circ}C$. These animals succumbed at that low temperature, and the changes of heart rate and loss of myocardial catecholamines after hypothermia were similar to those of normal animals. The actual effect of DCI preventing the ventricular fibrillation is not predictable. 3) Administration of reserpine(1 mg/kg, i.m.) 24 hours Prior to hypothermia disclosed reduced incidence of ventricular fibrillation, that is, six of the nine animals went into fibrillation at an average temperature of $19.6^{\circ}C$. By reserpine myocardial catecholamines content dropped to $0.045\;{\mu}g/g$ wet weight. 4) Bretylium pretreatment(20 mg/kg, i.m.), which blocks the release of catecholamines, Prevented the ventricular fibrillation under hypothermia in four of the eight cats. The pulse rate, however, was approximately the same as control and in some cases was rather slower. 5) Six cats treated with norepinephrine(2 mg/kg, i.m.) or DOPA(50 mg/kg) and tranylcypromine(10 mg/kg), which tab teen proved to cause significant increase in the catecholamines content of the heart muscle, showed ventricular fibrillation in all animals under hypothermia at average temperature of $21.6^{\circ}C$ and the pulse rate increased remarkably as compared with that of normal. Catecholamines content of cardiac muscle of these animals markedly decreased after hypothermia but higher than control animals. 6) The functional refractory periods of isolated rabbit atria, determined by the paired stimulus technique, was markedly shortened by administration of epinephrine, norepinephrine and isoproterenol. 7) Adrenergic beta-blocking agents, such as pronethalol, propranolol and sotalol(MJ-1999), inhibited completely the shortening of refractory period induced by norepinephrine. 8) Pretreatment with either phenoxftenbamine or phentolamine, an adrenergic alphatlocking agent, did not modify the decrease in refractory period induced by norepinephrine. From the above experiment it is possible to conclude that catecholamines play an important role in producing ventricular fibrillation under hypothermia. The shortening of the refractorf period of cardiac muscle induced by catecholamines mar be considered as a partial factor in producing ventriculr fibrillaton and to be mediated by beta-adrenergic receptor.

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Control of Atrial Fibrillation in Mitral Valvular Heart Surgery [90 Cases] (승모판막 수술환자에서의 심방세동에 관한 치료관찰)

  • 곽문섭
    • Journal of Chest Surgery
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    • v.18 no.4
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    • pp.679-691
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    • 1985
  • Ninety patients underwent mitral valvular heart surgery associated with or without aortic valve surgery and subjected to a clinical study in relation to their control of postoperative atrial fibrillation. There were 26 males and 64 females ranged in age from 16 to 56 years with a mean of 35.2 years. Systemic arterial embolizations were observed in 11 patients [12.2%]. Four patients of them were in normal sinus rhythm and 7 in atrial fibrillation. Out of these, left atrial thrombi were found only in 2 at the operation. Intraoperatively confirmed left atrial thrombi were in 16 patients [17.7%] of all 90 patients: Eleven patients occurred at the age of more than 40 years, 14 were in atrial fibrillation and 2 only had previous episodes of systemic arterial embolization. Sixty three patients underwent isolated mitral valve surgery [OMC 28, MVR 35] and 27 patients associated with aortic valve surgery along with mitral valve [OMC+AVR 13, MVR+AVR 14]. Preoperatively, 44 patients [48.9%] were in normal sinus rhythm. Of them, 35 patients [79.5%] revealed normal sinus rhythm thoroughly after operation without any aid of digitalis or quinidine and 5 patients [11.4%] restored normal sinus rhythm with digitalization alone. Other 3 patients converted to normal sinus rhythm with the addition of quinidine, however, in 1 patient who was resistant to quinidine therapy, electrocardioversion was carried out on the postoperative third week showing normal sinus rhythm. Thus, the most atrial fibrillations that occurred for the first time in the postoperative period, were able to reverted to normal sinus rhythm responding well to antiarrhythmic therapy. Preoperatively, 46 patients [51.1%] were in atrial fibrillation. Of them, only 5 patients returned to sinus rhythm after operation without any aid of digitalis or quinidine and other 5 restored normal sinus rhythm with digitalization: namely 2 restored within early postoperative period and 3 after more than 3 months. Eight patients well responded to quinidine therapy showing normal Sinus rhythm. So far, 25 patients have remained in persistent atrial fibrillation on 6 to 36 months follow-up. In view of these, 17 patients [68%] were over 40 years of age, 22[80%] had long duration of symptom over 5 years and 10[40%] have had atrial thrombi before operation. Left atrial dimension were still more than 40mm in 21 patients on follow up M-mode echocardiogram. One month after operation, 87 hospital survivors were improved by at least one functional NYHA class. There were 3 operative deaths [3.3%, bleeding 1, LCOS 2] and 4 late deaths [LCOS 1, valve thrombosis 1, late bleeding 1, fulminant hepatitis 1] during follow-up period. According to our limited experience, we may conclude that better results will be expected with the addition of quinidine therapy judiciously in the cases of postoperative persistent atrial fibrillation who were aged or had longer history of symptom and left atrial thrombi.

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A Comparative Study of USA and Europe Guidelines of Rate and Rhythm Control Pharmacotherapy in Atrial Fibrillation (심방세동 치료를 위한 미국과 유럽의 심박수 및 율동 조절 약물요법 가이드라인 비교 연구)

  • Jung, Eun Joo;Sohn, KieHo;Baek, In-Hwan
    • Korean Journal of Clinical Pharmacy
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    • v.26 no.1
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    • pp.84-95
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    • 2016
  • Objective: Atrial fibrillation (AF) guidelines have been published in the USA and Europe. Recently, the USA and Europe have updated their guidelines, respectively. These new AF guidelines help in addressing key management issues in clinical situations. This study, therefore, systematically compared guidelines for rate and rhythm control pharmacotherapy of patients with AF between the USA (American College of Cardiology and American Heart Association, ACC/AHA) and Europe (European Society of Cardiology, ESC). Methods: This study investigated and compared American guidelines (2014) and European guidelines (2010 and 2012). Results: Generally, there are four meaningful differences between ACC/AHA and ESC guidelines. Important differences are treatment classification system, level of recommendation, drug list, and dosage. In addition, ACC/AHA described pharmacokinetic drug interactions for antiarrhythmic drugs. ESC emphasized ECG and atrioventricular nodal slowing as feature of antiarrhythmic drugs. Conclusion: This research addresses important use of anti-arrhythmic drugs and movement to accept recent recommendations in Korea. For the successful application of the guidelines, a role of pharmacists is crucial in clinical situation.