ABSTRACT
BACKGROUND: Clinically silent lesions on cerebral magnet resonance imaging have been found in larger numbers after pulmonary vein isolation (PVI) especially with phased radio frequency (pRF) using all ten electrodes. However, the neuropsychological effects of cerebral microembolism during the procedure remain unclear and data regarding this issue so far are inconsistent. METHODS: Between August 2011 and June 2012, 76 patients undergoing their first PVI were randomized to ablation with either phased (40) or irrigated (36) radio frequency (iRF). A comprehensive neuropsychological test battery was performed the day before and after PVI as well as 6 months after ablation. The occurrence of cerebral microemboli during the procedure was performed via a transcranial Doppler ultrasound device. RESULTS: PVI using pRF was associated with increased number of microembolic signals (MES) compared to iRF (1530.0 ± 979.8 vs. 645.7 ± 448.7; p < 0.001). Neuropsychological assessment did not reveal any changes in correlation with the used ablation technique. Besides an age-related effect there was a diffuse, sub-clinical impairment of neurologic function depending on age and the number of MES. CONCLUSIONS: There was no clinical overt cognitive deficit and no significant difference in cognitive function correlating with the used ablation technique. The number of MES correlated with a subtle, diffuse post-procedural impairment of neuropsychological function highlighting the need to reduce microemboli during ablation.
Subject(s)
Atrial Fibrillation/surgery , Catheter Ablation/adverse effects , Cognition Disorders/psychology , Cognition , Intracranial Embolism/psychology , Aged , Atrial Fibrillation/diagnosis , Catheter Ablation/methods , Cognition Disorders/diagnosis , Cognition Disorders/etiology , Female , Germany , Humans , Intracranial Embolism/diagnosis , Intracranial Embolism/etiology , Male , Middle Aged , Neuropsychological Tests , Predictive Value of Tests , Prospective Studies , Risk Factors , Therapeutic Irrigation/adverse effects , Time Factors , Treatment Outcome , Ultrasonography, Doppler, TranscranialABSTRACT
Class I antiarrhythmic drugs are sodium channel inhibitors that act by slowing myocardial conduction and, thus, interrupting or preventing reentrant arrhythmia. Due to proarrhythmic effects and the risk of ventricular tachyarrhythmia, class I antiarrhythmics should not be administered in patients with structural heart disease. Nevertheless, there remains a broad spectrum of arrhythmias--among the most common being atrial fibrillation--that can successfully be treated with class I antiarrhythmic drugs. This review gives an overview on the classification, antiarrhythmic mechanisms, indications, side effects, and application modes of class I antiarrhythmic drugs.
Subject(s)
Anti-Arrhythmia Agents/classification , Anti-Arrhythmia Agents/therapeutic use , Arrhythmias, Cardiac/drug therapy , Sodium Channel Blockers/classification , Sodium Channel Blockers/therapeutic use , Administration, Oral , Adrenergic beta-Antagonists/therapeutic use , Anti-Arrhythmia Agents/adverse effects , Arrhythmias, Cardiac/chemically induced , Arrhythmias, Cardiac/mortality , Atrial Fibrillation/drug therapy , Atrial Fibrillation/mortality , Contraindications , Dose-Response Relationship, Drug , Drug Therapy, Combination , Electrocardiography/drug effects , Female , Heart Failure/complications , Heart Failure/drug therapy , Humans , Infusions, Intravenous , Myocardial Infarction/complications , Myocardial Infarction/drug therapy , Pregnancy , Randomized Controlled Trials as Topic , Sodium Channel Blockers/adverse effects , Tachycardia, Atrioventricular Nodal Reentry/drug therapy , Tachycardia, Supraventricular/drug therapy , Tachycardia, Ventricular/drug therapyABSTRACT
Atrial fibrillation is associated with a relevant risk for ischemic stroke: Observational studies suggest that one in four to five strokes is due to atrial fibrillation. Depending on the risk profile of an individual patient, the yearly risk for a stroke is between 2% and 14%. Continuous oral anticoagulation is indicated if atrial fibrillation is accompanied by at least one additional risk factor for thromboembolic complications. This recommendation is supported by several large randomized trials. Due to their low therapeutic range, vitamin K antagonists (phenprocoumon, warfarin, and others), the most commonly used oral anticoagulants, require regular anticoagulation monitoring. If well-controlled (international normalized ratio 2-3, in elderly patients preferably 2-2.5), oral anticoagulation prevents more than half of ischemic strokes related to atrial fibrillation, while bleeding complications are rare. In the follow-up of low risk patients (CHADS2-Score 0), oral anticoagulation becomes necessary when risk factors for thromboembolic complications develop. If a stroke occurs during oral anticoagulation and an INR>2 in a patient with atrial fibrillation, other causes than thromboembolic events should be considered. New anticoagulants--especially direct thrombin antagonists--are currently evaluated in clinical trials and may in the future facilitate anticoagulation in patients with atrial fibrillation.
