Olshansky, B. (2015, October 29). Atrial fibrillation - management, the challenge and new solutions 2 [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved February 29, 2024, from https://hstalks.com/bs/3118/.
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Published on October 29, 2015
Prof. Brian Olshansky has not informed HSTalks of any commercial/financial relationship that it is appropriate to disclose.
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another important issuewith regard to
the management of patientswith atrial fibrillationand that is
ventricular rate control.
Here is a Holter monitor
of a patientwho had apparent rate control.At about 1 o'clock
in the afternoon,this patient came to clinicand was found
to have a heart rateof 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 dayand 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 alonemay not be effective in terms
of symptomatic managementor management
of atrial fibrillation at all.So what is adequate rate control
is a hard thing to define.But it really means
that the patientsgenerally have heart rates
in the physiologic rangethat would be expected
for that individualat a specific point in timeand that is
yet to be better definedbecause some of the data
would suggest that that rateshould be in the 80 beat
per minute rangeand other data would suggestit should be
even higher than that.
We showed several years ago,that rapid rates, especially
from ventricular tachycardias,especially
from atrial fibrillation,can cause a cardiomyopathy.And this tachycardia-induced
cardiomyopathywhich develops slowly
due to rapid ratescan lead to heart failure.And it's partially reversible,but over time it can lead
to remodeling of the heartand can lead
to the risk of sudden death.This is something
you do not want to have,this is something
that may be avoidableby adequate rate control
in atrial fibrillation.So what are the datain terms
of randomized controlledclinical trials
that show benefitin terms of rate control?