Atrial fibrillation - management, the challenge and new solutions 2

Published on October 29, 2015   29 min

Other Talks in the Category: Biochemistry

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?
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Atrial fibrillation - management, the challenge and new solutions 2

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