THE IMPORTANCE OF EARLY CARDIOVERSION OF PAROXYSMAL ATRIAL FIBRILLATION
Abstract
Background. Atrial fibrillation is one of the most common arrhythmias. There is a traditional division by time course into acute and chronic forms. The classification of acute forms is unsatisfactory. Paroxysmal atrial fibrillation is one of the acute forms. There is a great variation in the frequency, duration and clinical pictures of its episodes. These can be asymptomatic or may cause significant hemodynamic disturbances, more or less unpleasant for the patients. There is growing evidence that paroxysmal atrial fibrillation could confer a hypercoagulable state, which is well known for the chronic atrial fibrillation. The possibility of thromboembolic incidents increases with the duration of an episode of paroxysmal atrial fibrillation and is dependent on risk factors for thromboembolisms.
Conclusions. The early cardioversion of paroxysmal atrial fibrillation into sinus rhythm is indicated when significant hemodynamic disturbances are present. Pharmacological or electrical cardioversion could be used. The early cardioversion is also recommended, as the possibility of thromboembolic incidents in the first few hours is very low.There are no firm guidelines for profilactic anticoagulation during an attack of paroxysmal atrial fibrillation. The decision for permanent antithrombotic therapy of patients with paroxysmal atrial fibrillation is based on duration and frequency of episodes, on patient’s age, and risk factors for thromboembolisms in atrial fibrillation.
Downloads
References
Lau CP, Leung WH, Wong CK et al. Haemodynamics of individual atrial fibrillation: A comparative assessment with sinus rhythm, atrial and ventricular pacing. Eur Heart J 1990; 11: 219–24.
Wellens HJJ, Rodriguez LM, Smeets JLRM, Cheriex EC, Pieters F, Dulk K. Tachycardiopathy in patients with supraventricular tachycardia with emphasis on atrial fibrillation. In: Olsson SB, Allessie MA, Campbell RWF eds. Atrial fibrillation: Mechanisms and therapeutic strategies. Armonk, NY: Futura Publishing Co., 1994: 333–42.
Kamp O, Van Huizum MA, Verhorst PMJ et al. Left atrial flow velocity in patients with atrial fibrillation and systemic embolism (abstract). Circulation 1991; 84: Suppl II: II-411–II-411.
Hinton RC, Kistler JP, Fallon JT, Friedlich AL, Fischer CM. Influence of etiology of atrial fibrillation on incidence of systemic embolism. Am J Cardiol 1977; 40: 509–13.
Levy S. Nomenclature of atrial fibrillation or the Tower of Babel. J Cardiovasc Electrophysiol 1998; 9: 583–5.
Evans W, Swann P. Lone auricular fibrillation. Br Heart J 1954; 16: 189–94.
Lewis T. The value of quinidine in cases of auricular fibrillation. Am J Med Sci 1922; 164: 1–10.
Levy S, Novella P, Ricard P, Paganelli F. Paroxysmal atrial fibrillation: a need for classification. J Cardiovasc Electrophysiol 1995; 6: 69–74.
Levy S, Breithardt G, Campbell RWF et al. Atrial fibrillation: current knowledge and recommendations for management. Eur Heart J 1998; 19: 1294–320.
Gallager MM, Camm AJ. Classification of atrial fibrillation. PACE 1997; 20: 1603–5.
Goette A, Honeycutt C, Langberg JJ. Electrical remodeling in atrial fibrillation. Time course and mechanisms. Circulation 1996; 94: 2968–74.
Wijffels MC, Kirchhof CJ, Dorland R, Allessie MA. Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation 1995; 92: 1954–68.
Alboni P, Scarfo S, Fuca G, Paparella N, Yannacopulu P. Hemodynamics in idiopathic paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 1995; 18: 980–5.
Van den Berg MP, Hassink RJ, Tuinenburg AE, van Sonderen EFLP, Lefrandt JD, de Kam PJ, van Gelder IC et al. Quality of life in patients with paroxysmal atrial fibrillation and its predictors: importance of the autonomic nervous system. Eur Heart J 2001; 22: 247–53.
Nattel S, Hadjis T, Talajic M. The treatment of atrial fibrillation – an evaluation of drug therapy, electrical modalities and therapeutic considerations. Drugs 1994; 48: 345–71.
Cotter G, Blatt A, Kaluski E et al. Conversion of recent onset paroxysmal atrial fibrillation to normal sinus rhythm: the effect of no treatment and high-dose amiodarone. Eur Heart J 1999; 20: 1833–42.
Michael JA, Stiell IG, Agarwal S, Mandavia DP. Cardioversion of paroxysmal atrial fibrillation in the emergency department. Ann Emerg Med 1999; 33: 79–87.
Virchow R. Gesammelte Abhandlungen zur wissenschaftlichen Medizin. Medinger Sohn & Co., 1856: 219–9.
Obarski TP, Salcedo EE, Castle LW, Stewart WJ. Spontaneous echo contrast in the left atrium during paroxysmal atrial fibrillation. Am Heart J 1990; 120: 988–90.
Jafri SM, Ozawa T, Mammen E, Levine TB, Johnson C, Goldstein S. Platlet function, thrombin and fibrinolytic activity in patients with heart failure. Eur Heart J 1993; 14: 205–12.
Stoddard MF, Dawkins PR, Prince CR, Ammash NM. Left atrial appendage thrombus is not uncommon in patients with acute atrial fibrillation and a recent embolic event: a transesophageal study. J Am Coll Cardiol 1995; 93: 1262–77.
Lip GYH. Atrial fibrillation and hypertension: under-recognised or overdiagnosed? J Hum Hypertens 1997; 77: 407–11.
Stroke Prevention in Atrial Fibrillation Committee on Echocardiography. Transesophageal echocardiographic correlates of thromboembolism in high-risk patients with atrial fibrillation. Ann Intern Med 1998; 128: 639–47.
Lechner K, Korninger C, Niessner H, Thaler E. Gesichertes und Ungesichertes in der Diagnostik der Thrombophilie. Med Welt 1983; 34: 103–7.
Amiral J. Molecular markers in thrombosis and hemostasis. Clin Appl Thrombosis Hemostasis 1997; 3: 71–81.
Lip GYH. Does atrial fibrillation confer a hypercoagulable state? Lancet 1995; 346: 1313–4.
Lip GYH, Lowe GD, Rumley A, Dunn FG. Increased markers of thrombogenesis in chronic atrial fibrillation: efects of warfarin treatment. Br Heart J 1995; 73: 527–33.
Cleland JGF, Cowburn PJ, Falk RH. Should all patients with atrial fibrillation receive warfarin? Evidence from randomized clinical trials. Eur Heart J 1996; 17: 674–81.
Lip GYH, Gibbs CR. Does heart failure confer a hypercoagulable state? Virchow’s triad revisited. J Am Coll Cardiol 1999; 33: 1424–6.
Lip GYH, Blann AD. Does hypertension confer a prothrombotic state? Circulation 2000; 101: 218–20.
Sohara H, Miyahara K. Effect of atrial fibrillation on the fibrino coagulation system: study in patients with paroxysmal atrial fibrillation. Jpn Circ J 1994; 58: 821–6.
Climent VE, Roldan V, Ibanez A, Marin F, Martinez-Tur JV, Monmeneu JV et al. Paroxysmal non-rheumatic atrial fibrillation does not show a prothrombotic state. Eur Heart J 1999; 20: Suppl: 353–3.
Sohara H, Amitani S, Kurose M, Miyahara K. Atrial fibrillation activates platlets and coagulation in a time-dependent manner: A study in patients with paroxysmal atrial fibrillation. J Am Coll Cardiol 1997; 29: 106–12.
Giansante C, Fiotti N, Miccio M, Altamura N, Salvi R, Guarnieri G. Coagulation indicators in patients with paroxysmal atrial fibrillation: effects of electrical and pharmacological cardioversion. Am Heart J 2000; 140: 423–9.
Laupacis A, Albers G, Dalen J, Dunn M, Feinberg W, Jacobson A. Antithrombotic therapy in atrial fibrillation. Chest 1998; 114: 579S–89S.
Weigner MJ, Caulfield TA, Danias PG, Silverman DI, Manning WJ. Risk for clinical thromboembolism associated with conversion to sinus rhythm in patients with atrial fibrillation lasting less than 48 hours. Ann Intern Med 1997; 126: 615–20.
Hart RG, Pearce LA, Rothbart RM, McAnulty JH, Asinger RW, Halperin JL. Stroke prevention in atrial fibrillation investigators. Stroke with intermittent atrial fibrillation: incidence and predictors during aspirin therapy. J Am Coll Cardiol 2000; 35: 183–7.
Page RL, Wilkinson WE, Clair WK, McCarthy EA, Pritchett EL. Asymptomatic arrhythmias in patients with symptomatic paroxysmal atrial fibrillation and paroxysmal. supraventricular tachycardia. Circulation 1994; 89: 224–7.
Lip GYH. Does paroxysmal atrial fibrillation confer a paroxysmal thrombembolic risk? Lancet 1997; 349: 1565–6.
Lip GYH. The prothrombotic state in atrial fibrillation: New insights, more questions, and clear answers needed. Am Heart J 2000; 140: 348–50.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
