Friday, May 25, 2007
ELECTRICAL CARDIOVERSION FOR AF THE STATE OF THE ART
DIT IS EEN GOEDE SAMENVATTING VAN HET ARTIKEL.
Future Developments/Research
While the overall technique of cardioversion has changed little over the past 40 years, there have been a number of technical developments which have improved acute success rates. These include the rigorous attention to technical detail, biphasic cardioversion, and the use of adjuvant drugs for almost all from the start, including anti-arrhythmics and others. For those who remain resistant to this approach, internal cardioversion remains a potential option. The major challenge however is the prevention of recurrence; this can certainly be improved with conventional adjuvant anti-arrhythmics, probably with angiotensin converting enzyme (ACE) inhibition, and possibly with calcium antagonists in addition. A large trial examining the combination of all of these would be of great interest. It should of course be emphasized that a single recurrence on one anti-arrhythmic does not necessarily mean that the option has failed; for some patients infrequent periodic cardioversion, perhaps once a year, may be a very satisfactory result. In spite of the negative findings from ACUTE, it seems reasonable to cardiovert as early as practicable. In the future, the continued development of AF ablation will change the role of cardioversion; the return of sinus rhythm is only the start of the process. It is likely that the technique will further develop with new shock waveforms,[111] new anti-coagulants,[112] and novel atrial-selective anti-arrhythmics.[113] Cardioversion should therefore not be considered a strategy in itself, more part of a number of anti-arrhythmic strategies which can be selected for patients on an individual basis involving medication, ablation, and device therapies.
Future Developments/Research
While the overall technique of cardioversion has changed little over the past 40 years, there have been a number of technical developments which have improved acute success rates. These include the rigorous attention to technical detail, biphasic cardioversion, and the use of adjuvant drugs for almost all from the start, including anti-arrhythmics and others. For those who remain resistant to this approach, internal cardioversion remains a potential option. The major challenge however is the prevention of recurrence; this can certainly be improved with conventional adjuvant anti-arrhythmics, probably with angiotensin converting enzyme (ACE) inhibition, and possibly with calcium antagonists in addition. A large trial examining the combination of all of these would be of great interest. It should of course be emphasized that a single recurrence on one anti-arrhythmic does not necessarily mean that the option has failed; for some patients infrequent periodic cardioversion, perhaps once a year, may be a very satisfactory result. In spite of the negative findings from ACUTE, it seems reasonable to cardiovert as early as practicable. In the future, the continued development of AF ablation will change the role of cardioversion; the return of sinus rhythm is only the start of the process. It is likely that the technique will further develop with new shock waveforms,[111] new anti-coagulants,[112] and novel atrial-selective anti-arrhythmics.[113] Cardioversion should therefore not be considered a strategy in itself, more part of a number of anti-arrhythmic strategies which can be selected for patients on an individual basis involving medication, ablation, and device therapies.
# posted by roodbont @ 12:48 PM 
