Atrial Fibrillation, a Treatable Disease?

310 Pages·1992·7.85 MB·English

by  Norbert M. van Hemel

Atrial Fibrillation,
a Treatable Disease?
Edited by
J. H. Kingma
N. M. van Hemel
Department of Cardiology,
St. Antonius Hospital,
Nieuwegein, The Netherlands
and
K.1. Lie
Department ofCardiology,
Thorax-center, University Hospital Groningen,
Groningen, The Netherlands
Springer Science+Business Media, B.V.
ISBN 978-94-010-4801-9 ISBN 978-94-011-1816-3 (eBook)
DOI 10.1007/978-94-011-1816-3
Printed on acid-free paper
AII Rights Reserved
@ 1992 Springer Science+Business Media Dordrecht
Originally published by Kluwer Academic Publishers in 1992
No part of the material protected by this copyright notice may be reproduced or
utilized in any form or by any means, electronic or mechanical,
including photocopying, recording or by any information storage and
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Developments in
Cardiovascular Medicine
VOLUME 139
The titles published in this series are listed at the end of this volume.
ATRIAL FIBRll..LATION, A TREATABLE DISEASE?
CONTENTS
Foreword Philippe Coumel xi
Preface J. Herre Kingma, Norbert M. van Hemel, Kong I. Lie xv
Acknowledgements xix
SECTION 1: Concepts and Clinics of Atrial Fibrillation
Chapter 1 From Experiment to Therapeutic Innovation in Atrial
Fibrillation and Flutter.
Norbert M. van Hemel, Jacques M. T. de Bakker, Anand Ramdat
Misier, Jo A.M. Defauw.
Introduction 2
The sinus node in atrial fibrillation 2
Refractory periods and atrial fibrillation 4
A theory to explain the different conversion rate of atrial
fibrillation and flutter after Class Ic antiarrhythmics 8
Nonpharrnacologic treatment of atrial flutter 10
Nonpharmacologic treatment of atrial fibrillation 12
Concluding remarks 19
Chapter 2 Atrial Functional Anatomy. 23
Gerard M. Guiraudon, Colette M. Guiraudon.
Introduction 24
Gross anatomy 24
Functional anatomy 36
Hemodynamic function 36
Comments 39
Chapter 3 The Pathology of Drug Resistant Lone Atrial Fibrillation
in Eleven Surgically Treated Patients. 41
Colette M. Guiraudon, Nicolette M. Ernst, Gerard M. Guiraudon,
Raymond Yee, George J. Klein.
Introduction 42
Material and Methods 42
Results 44
Comments 53
Discussion 54
Conclusion 56
vi
Chapter 4 Termination of Atrial Fibrillation by Class Ic Antiarrhyth
mic Drugs, a Paradox? 59
Maurits A. Allessie, Charles Kirchhof.
Pathophysiologic mechanisms of atrial fibrillation 60
The wavelength concept 61
The substrate of atrial fibrillation 62
The antifibrillatory action of Class Ic drugs 63
Chapter 5 Characteristics of Patients with Chronic Atrial Fibrillation
and the Prediction of Successful DC Electrical Car
dioversion. 67
Isabelle C. van Gelder, Harry J.G.M. Crijns, Kong I. Lie.
Introduction 68
Characteristics of patients with chronic atrial fibrillation 69
Therapeutic strategy of chronic atrial fibrillation 72
Direct current electrical cardioversion 72
Immediate outcome of DC electrical cardioversion 75
Complications 79
Summary and guideline 82
SECTION 2: Recent Advances in the Treatment of Paroxysmal
Atrial Fibrillation and Flutter
Chapter 6 Pharmacological Cardioversion of Paroxysmal Atrial
Fibrillation or Atrial Flutter to Sinus Rhythm. 87
Maarten J. Suttorp, Emile R. Jessurun, J. Herre Kingma.
Introduction 88
Possible mechanisms of antiarrhythmic drug effects 89
Acute pharmacological intervention of atrial fibrillation or
flutter 90
Conclusions 99
Chapter 7 Drugs After Cardioversion to Prevent Relapses of
Chronic Atrial Fibrillation or Flutter. 105
Harry J.G.M. Crijns, A. T. Marcel Gosselink, Isabelle C. van Gelder,
Ans C.P. Wiesfeld, Maarten P. van den Berg, Ype S. Tuininga,
Kong I. Lie.
Introduction 106
Why prophylactic treatment after cardioversion? 106
Paroxysmal or chronic atrial fibrillation? 10 7
Definition of chronic arrhythmia 107
vii
Recurrence rate with or without prophylactic antiarrhythmic
treatment 108
Postcardioversion antiarrhythmic drug studies 109
Amiodarone in atrial fibrillation complicated by heart failure 120
Serial treatment 121
Differential effects of Class I and Class III antiarrhythmics on
ventricular rate during atrial fibrillation: implication for clinical
practice 123
Antiarrhythmics in the prevention of atrial fibrillation in the
WPW-syndrome 125
Proarrhythmia during treatment of atrial fibrillation or flutter 126
General guidelines for drug treatment after cardioversion 139
Chapter 8 Episodic Treatment of Paroxysmal Atrial Fibrillation. 149
Loraine Lie-A-Huen, J. Herre Kingma.
Introduction 150
Development of episodic treatment until now 151
(Dis)advantages 151
Paroxysmal atrial fibrillation 152
The 'ideal' formulation 155
Conclusion 157
Chapter 9 An AICD for Atrial Fibrillation? 159
Andrew M. Tonkin, Jonathan M. Kalman, Norma Gil/i.
Introduction 160
Animal experimentation 160
Application to humans 162
Sensing algorithms 164
Conclusions 164
Chapter 10 The 'Corridor' Operation as an Alternative in the Treat
ment of Atrial Fibrillation. 167
Jo AM. Defauw, Norbert M. van Hemel, J. Herre Kingma, Wybren
Jaarsma, Freddy E.E. Vermeulen, Jacques M. T. de Bakker, Gerard
M. Guiraudon.
Introduction 168
Methods 168
Surgical procedure and in-hospital electrophysiologic studies 170
Results 174
Discussion 176
Conclusions 180
viii
SECTION 3: Why Aggressive Therapy in Atrial Fibrillation?
Chapter 11 Tachycardiomyopathy in Patients with Supraventricular
Tachycardia. 183
Hein J.J. Wellens, Luz-Maria Rodriquez, Joep L.R.M. Smeets,
Emile C. Cher/ex, Frans Pieters, Karel den Dulk.
Introduction 184
Pathophysiologic background 184
Observations in the human heart 184
Practical implications 192
Chapter 12 Sinus Rhythm, the Autonomic Nervous System, and
Quality of Life. 195
Francis D. Murgatroyd, A. John Camm.
Introduction 196
Autonomic factors 196
Electrophysiology of AF patients In SR 201
Quality of life 205
Conclusions 208
Chapter 13 Atrial Tachyarrhythmias Following Coronary Bypass
Surgery: Sympathetic Mechanisms. 211
Jonathan M. Kalman, Muhammad Munawar, Anthony Yapanls,
Laurence G. Howes, William J. Louis, Brian F. Buxton, Lawrence
A. Doolan, Jane Tippett, Andrew M. Tonkin.
Introduction 212
Methods 214
Results 215
Discussion 220
Chapter 14 Management of Paroxysmal Atrial Fibrillation and Atrial
Flutter Shortly after Coronary Artery Bypass Graft
Surgery. 227
Maarten J. Suttorp, J. Herre Kingma, Norbert M. van Hemel,
Jo A.M. Defauw, Freddy E.E. Vermeulen, Sjef M.P.G. Ernst.
Introduction 228
Cardiovascular risk factor analysis for developing post-
operative supraventricular tachyarrhythmias 229
ix
Prevention of supraventricular tachyarrhythmias after cardiac
surgery 230
Conclusions 234
Chapter 15 Risk and Prevention of Embolism in Atrial Fibrillation. 237
A. T. Marcel Gosselink, Harry J.G.M. Crijns, Kong I. Lie.
Introduction 238
Prevalence and Incidence of atrial fibrillation 238
Underlying heart disease 238
Atrial fibrillation and stroke 239
Mechanisms of embolism 243
Prevention of embolism -antithrombotic therapy 244
Antithrombotics in cardioversion of atrial fibrillation 251
Summary and recommendation 252
Chapter 16 Value of Left Atrial Appendage Flow Velocities in
Patients with Nonrheumatic Atrial Fibrillation and
Systemic Embolism. 259
Otto Kamp, Patrick M.J. Verhorst, Cees A. Visser.
Introduction 260
Methods 260
Statistics 263
Results 263
Discussion 265
Limitations of the present study 267
Clinical implications 267
Chapter 17 Management of Atrial Fibrillation: From Palliation to
Intervention. 271
J. Herre Kingma, Maarten J. Suttorp, Willem P. Beukema.
Introduction 272
General approach to atrial fibrillation 272
Clinical management 277
Conclusions 282
Index 285
FOREWORD
by Philippe Coumel
The atrium is a particularly convenient tool for the electrophysiologist in
experimental as well as clinical conditions. Curiously, the atrium was relatively
neglected during the early years of clinical electrophysiology when attention
was focused on the atrioventricular junction, and then on the ventricle. At the
junctional level, the progress of knowledge was very fast and fruitful. In the
ventricle some disappointment came from therapeutic conclusions drawn from
invasive as well as noninvasive investigations. This was partly due to concepts
developed in a too straightforward way, making artificially-induced tachy
arrhythmias, or spontaneous trivial arrhythmias supposedly reliable surrogates
of the real phenomena that finally lead to death. With these considerations in
mind, one realizes how important it is to pay more attention to atrial fibrillation.
The ventricle and the atrium may develop identical electrophysiological
mechanisms of arrhythmias such as reentry, automaticity and triggered
activity. Although, the causal diseases are different at each level the fibrillation
process represents something like the end of the road and poses the most
difficult problems of comprehension and treatment. At this point, the atrium
possesses considerable advantages over the ventricle. Two are of paramount
importance. For the investigator the atrium has the advantage of being a two
rather than a three-dimensional tissue, which makes it very easy to explore
precisely and completely, to map, to represent and to model with computers.
For the clinician the atrium has the definite advantage not to be hemodynami
cally essential, so that fibrillation does not directly threaten life: the practical
consequence is, that therapeutic errors that are catastrophic in the ventricle
are forgivable in the atrium.
Although obvious, one must realize how much this difference in the
hemodynamic consequences of fibrillation completely changes the situation
from every viewpoint. As long as the first therapeutic mistake is the last one,
xi