engleski

Outcome of pharmacological treatment of patients with atrial fibrillation in the emergency room

Two pharmacological approaches are established in treatment of atrial fibrillation (AF): "rythm control" - the usage of antiarrhytmic agents, in order to restore and maintain normal sinus rythm (NSR), and "rate control" - the usage of agents wich prolong cardiac atrioventricular conduction, in order to alleviate clinical symptoms. This study examines the epidemiology and the otucome of pharmacological treatment of patients with AF in the emergency room (ER). Discharge Letters of all patients admitted to the ER and subsequently diagnosed with AF over one-year period were reviewed (May 2001 - May 2002). Data on age, gender, symptoms duration, drugs administered and outcome of treatment were analysed. Patients with AF were classified in three categories: patients with paroxysmal AF (duration of episode of fibrillation less than 7 days), persistent AF (episode longer than 7 days), and permanent AF. In this study, the main outcome measure was set up as restoration of normal sinus rhythm or rate control achieved within 24 hours upon admission. In one year period, AF was registered in 242 patients, which represented 4% of total medical emergency admissions (n=6142). In patients with AF, 64 % (n=152) had paroxismal AF, 12% (n=29) had persistent AF, and 24% (n=58) patientns had permanent AF. In group of patients with paroxismal AF, pharmacological conversion into NSR was attempted in 74% patients (n=113). "Rythm control" was achieved in 50% (n=56) of patients, "rate control" in 12% (n=14) and 38% (n=43) of patients required prolonged hospital treatment. The antiarrythmic drug of choice was propafenon, with conversion attempted in 62% pts (n=71) and control achieved in 61% (n= 43), and amiodarone, with conversion attempted in 7% of pts (n=8), and rythm control achieved in 50% pts (n=4). In group of patients with persistent AF (n=29), pharmacological treatment was attempted in 79% pts (n= 23). "Rythm control" was achieved in 17% pts (n=4), "rate control" in 43% pts (n=10), and 40% pts (n=9) required prolonged hospital treatment. In this group of patients the drug of choice was propafenon with conversion attempted in 43% pts (n=10), and control achived in 20% pts (n=2).In group of patients with permantent AF (n=58), pharmacological treatment was attempted in 69% pts (n=40). "Rate control" was achieved in 50% (n=20) patients, whereas the others required prolonged hospital treatment. The pharmacological drug of choice was combination of verapamil and digoxine, with 81% success rate. AF is the most common cardiac arrthymia presented at the emergency room. "Rythm control" approach still represents the main target in the treatment of patients with AF presented in the emergency room, whereas "rate control" is attempted in patients with persistent and permanent AF.

atrial fibrillation ; antiarrhytmic drugs ; emergency room

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