Atrial fibrillation (AF) ?Detailed Overview
ARTICLE
In recent years, management strategies for atrial fibrillation (AF) have expanded significantly, and new drugs for ventricular rate control and rhythm conversion have been introduced1. The atrial fibrillation (AF) surgery in India provides you the world class facilities at a very affordable price. Family physicians, handling such cases whether in office practice or in emergencies have the challenge of keeping current with recommendations on heart rate control, anti-arrhythmic drug therapy, cardio version, and antithrombotic therapy.
AF is the most common sustained arrhythmia encountered in the primary care setting. Many people in the general population have permanent or intermittent AF and the prevalence of arrhythmia increases in persons older than 80 years. AF can result in serious complications, including congestive heart failure, myocardial infarction, and thrombo-embolism.
Recognition and acute management of AF in the physician’s office or emergency department are important in preventing adverse consequences.
It is important to note that AF occurring in a background of rheumatic heart disease as is rampant in India is decidedly associated with increased risk of stroke than that without. In the Framingham study2, patients with rheumatic heart disease and AF had a 17-fold increased risk of stroke compared with age matched controls, and the attributable risk was 5 times greater than in those with non-rheumatic AF2.
INTRODUCTION
No arrhythmia is unique to anesthesia practice. Anesthesia may per se potentate the risk of developing arrhythmia in an individual, but more particularly in those susceptible. Cardiac arrhythmias are a relatively frequent occurrence during anesthesia. The possible precipitating factors include: hypoxia, hypercapnia, myocardial infarction, catecholamine, electrolyte abnormalities, acid-base imbalance, drug toxicity and adverse drug reactions. The sudden appearance of any new arrhythmia, regardless of homodynamic consequences, should be of concern and warrants attention. Specific therapy in the form of drugs, cardio version, or pacing will have their efficacy greatly enhanced by prior institution of corrective measures. Frequently, drug or electrical therapy will not be required if aggravating factors are removed. We present this case where the patient had atrial fibrillations in the intraoperative period and no known cause could be attributed to it.
One treatment objective is directed to avoid the negative consequences of the arrhythmia by trying to maintain normal sinus rhythm. Two strategies exist to obtain this result:
1. Chronic treatment with antiarrhythmic drugs (AAD)
2. Catheter ablation of atrial fibrillation
1. AAD treatment tries to block or modulate the electrical activity of the heart avoiding initiation and perpetuation of the arrhythmia. It is effective in about 60% of patients and requires long-term treatment. Many of the drugs used have side effects, some of them disabling for the patient. Many drugs are available and combination of them might be used in case of failure. Compliance of the treatment is basic for long-term success.
2. Catheter ablation has emerged as an alternative to obtain stable sinus rhythm in this population. It has been demonstrated that a significant number of AF episodes initiate in the area of the pulmonary veins located in the left atrium. Using one or several catheters inserted through the femoral veins, they are inserted into the heart and brought to the left atrium through a transseptal approach. Once in the left atrium energy (radiofrequency, cold) is delivered in different areas (mainly around the pulmonary veins) to create lesions that block the electrical activity responsible for the arrhythmia. The effectiveness of this technique is around 70% and in about 25% a second procedure is needed to finish the ablation lines. As any invasive procedure some major complications may occur like cardiac tamponade (1%), thromboembolic events (0.5%) or atrio-esophageal fistula (1/1000). In case of success the patient does not requires continuation with AAD and the arrhythmia is cured.
The decision of which treatment to be used will have to be based on a number of considerations: type of patient, willingness of the patient, experience of the centre in ablative techniques, etc.
ATRIAL FIBRILLATION CAUSES
A variety of conditions can lead to atrial fibrillation. The most common cause of atrial fibrillation is simply aging. Our risk of atrial fibrillation increases as we grow older and areas of scarring or fibrosis develop in our atrial tissue as a result of simple “wear and tear.” Abnormalities of the valves in the heart, most often the mitral valve, can also cause “wear and tear” and lead to atrial fibrillation. Some specific conditions, such as thyroid disease, may be treatable with medications alone. Other conditions may be treatable by our colleagues the cardiologists in the cardiac catheterization laboratory. In a small number of cases, atrial fibrillation appears to be inherited – which is to say that it runs in some families – while in many cases its cause is unknown.
ATRIAL FIBRILLATION RESULTS
Atrial fibrillation results in:
An irregular heartbeat that may be too slow at times, and racing at others. Loss of the atrial contraction that normally contributes to filling of the ventricle (the main pumping chamber of the heart) and improves pump performance –in some ways analogous to an automobile engine supercharger. Abnormal flow of blood through the atrium with areas of stagnation (eddies) which increase the risk of stroke. SURGICAL PROCEDURE
The surgical procedure consists of creating a number of incisions in the atrium that disrupt the re-entrant circuits. Once the incisions are made, they are sewn together again. The atrium can then hold blood on its way to the ventricle and can squeeze or contract to push the blood in to the ventricle, but the electrical impulse cannot cross the incisions. The result is what looks like a children’s maze in which there is only one path that the electrical impulse can take from the SA node to the AV node. The atrium can no longer fibrillate, and sinus rhythm (the normal rhythm of the heart) is restored.
INDICATIONS
The MAZE procedure is not necessary in most patients with atrial fibrillation. Many patients are not bothered by the rhythm or the medications required controlling it. In some cases, cardiologists are able to disrupt the circuits with catheters. Some patients, however, are so troubled by the way they feel when they are in atrial fibrillation or by the medications they must take that a surgical option is appropriate. In addition, individuals in atrial fibrillation who have experienced a stroke are at significant risk for another stroke. The MAZE procedure may be indicated in these individuals as well.
CONCLUCIONS
Atrial fibrillations are common arrhythmias occurring in 0.4-5% of adult population and nearly 5%of these are not associated with cardiac disease. It is important to identify the precipitating factor and eliminate it. Anesthesia may trigger such arrhythmia.
MEDICAL TOURISM INDIA
India is one of the best places for the medical treatment or any other health care in India. Every year thousand of visitors are coming to India from around the world just for the medical check up and other type of surgery related cardiac or others diseases.
India is giving Thailand stiff competition in healthcare services for overseas patients with cost of surgery lower by over 30% and in fact cheapest in entire Southeast Asia. Medical tourism in fast emerging as a big opportunity for India with its low cost advantage, high quality healthcare providers and an English speaking populance. Heart Care Package India, Health Check up India. One of the best options to go for your treatment in India and have a India tour as well. In the same cost you can visit India and you can get your medical treatment done. Medical tourism India brings this choice for you. Go for medical tour in India and treat yourself with the best quality care in India. For more details on atrial fibrillation (AF) in India at an affordable cost feel free to visit us at www.indiancardiacsurgerysite.com or mail your queries at info@indiancardiacsurgerysite.com or talk to us at +91 9579119451.
