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0:04
Let's consider
another important issue
with regard to
the management of patients
with atrial fibrillation
and that is
ventricular rate control.
0:15
Here is a Holter monitor
of a patient
who had apparent rate control.
At about 1 o'clock
in the afternoon,
this patient came to clinic
and was found
to have a heart rate
of about 80 beats a minute.
A Holter monitor was applied
and as you can see here,
over the next ensuing day,
the heart rate fluctuated
throughout the day
and became quite fast
during some points in time.
This could explain symptoms,
it could explain
cardiomyopathy development,
it could explain the fact
that rate control alone
may not be effective in terms
of symptomatic management
or management
of atrial fibrillation at all.
So what is adequate rate control
is a hard thing to define.
But it really means
that the patients
generally have heart rates
in the physiologic range
that would be expected
for that individual
at a specific point in time
and that is
yet to be better defined
because some of the data
would suggest that that rate
should be in the 80 beat
per minute range
and other data would suggest
it should be
even higher than that.
1:19
We showed several years ago,
that rapid rates, especially
from ventricular tachycardias,
especially
from atrial fibrillation,
can cause a cardiomyopathy.
And this tachycardia-induced
cardiomyopathy
which develops slowly
due to rapid rates
can lead to heart failure.
And it's partially reversible,
but over time it can lead
to remodeling of the heart
and can lead
to the risk of sudden death.
This is something
you do not want to have,
this is something
that may be avoidable
by adequate rate control
in atrial fibrillation.
So what are the data
in terms
of randomized controlled
clinical trials
that show benefit
in terms of rate control?
