Cardio Ablation

The fibrillation of Atrial (AF) ae”general Detailed general Idea

ITEM

The latter years, the direction strategies for the fibrillation of atrial (AF) increased of in a significant way, and new drugs for the check of rate ventriculaire and the rhythm conversion were introduced1. The fibrillation of atrial (AF) surgery furnishes you to India the opportunities of international level to a very reasonable price. The family doctors, checking such case if in the practice of office or in the urgencies has the challenge on duty the current with the recommendations on the check of cardiac rhythm, the therapy of anti-arrhythmic drug, the version cardio, and the therapy of antithrombotic.
AF is the sustained arrhythmia the more met town in the primary cares that rule. A lot of persons in the general population has permanent or intermittent AF the predominance of increases of arrhythmia in the older persons than 80 years. AF can have for result of the serious complications, including the congestive cardiac insufficiency, the infarctus of the myocarde, and the thrombo-embolie.
The recognition and the sharp direction of AF in the office of the doctor or the service of the urgencies are important in to prevent the unfavorable consequences.
It is important to note that AF arrives in a bottom of disease of rheumatic heart as is soaring clearly is associated with India with the increased risk of blow that that without. In the Framingham study2, the patients with the disease of rheumatic heart and AF had one of 17 pleats increased the blow risk compare to the age check equalled, and the attributable risk was 5 bigger time than in those with not rheumatic AF2.

INTRODUCTION

No arrhythmia is unique to the practice of anesthedsie. The anesthedsie can by the potentate of itself risks it arrhythmia in the process of development in an individual, but notably in these susceptible one. The cardiac arrhythmias are a comparatively frequent event during the anesthedsie. The factors precipitating possible include: hypoxia, hypercapnia, the infarctus of the myocarde, catecholamine, the abnormalities of edlectrolyte, the acid imbalance bases, dope poisonousness and the unfavorable reactions of drug. The sudden appearance of new arrhythmia, without taking account of the consequences of homodynamic, should be worry and deserves the attention. Specific therapy in the form of a drugs, the version cardio, or traverse will have their strong effectiveness improved by the previous institution of measure corrective. Frequently, the drug or electric therapy will not be demanded if worsening of the factors are removed. We present this case where the patient had the fibrillations of atrial in the intra-opedratoire period and no known cause could be attributed him.

A treatment objective is directed to avoid the negative consequences of the arrhythmia while trying to maintain the rhythm of normal sinus. Two strategies exist to obtain this result:

1. The chronic treatment with the drugs of antiarrhythmic (AAD)

2. The removal of catheter of fibrillation of atrial

1. The treatment of AAD tries to block or to modulate the electric activity of the heart avoids the initiation and the perpetuation of the arrhythmia. It is effective in about 60% of patients and demands the treatment in the long term. A lot of the used drugs have secondary, certain effects of the rendering infirm for the patient. A lot of drugs are available and the combination of could be used them in case of failure. The accordance of the treatment is basic for the success in the long term.

2. Catheter removal emerged as an alternate one to obtain the rhythm of stable sinus in this population. It was shown that a significant number of episodes of AF establishes in the sector of the lung veins localized in the left auricle. The usage of one or more catheters inserted by the femoral veins, they are inserted in the heart and brought to the auricle left by one approach transseptal. Once in the energy of left auricle (the radiofrequency, the cold one) is delivered in the different sectors (principally around the lung veins) to create lesions that block the electric activity person in charge of the arrhythmia. The effectiveness of this technique is around 70% and in about 25% a second procedure is necessary to finish the removal lines. As the procedure invasive that some major complications can arrive as the events of thromboembolic of (1%), of cardiac tamponade (0.5%) or the fistula atrio-oesophagique (1/1000). In case of the success that the not done patient demands the extension with AAD and the arrhythmia is healed.

The decision of which treatment to be used will have to be based on a number of considerations: the type of patient, the kindness of the patient, the experience of the center in the technical ablatives, etc.

THE FIBRILLATION OF ATRIAL CAUSES

A condition selection can take to the fibrillation of atrial. The cause the more town of fibrillation of atrial ages simply. Our risk of increases of fibrillation of atrial as grow us older and the sectors to mark or the fibrosis develops in our fabric of atrial following the simple wear. The abnormalities of the valves in the heart, most often the mitral valve, can cause also the wear and take to the fibrillation of atrial. Some specific conditions, as the thyroid disease, can be traitables with only the medicines. The other conditions can be traitables by our colleagues the cardiologists in the laboratory of cardiac catheterization. In a small number of case, the fibrillation of atrial seems to be inherited - that is to say that it runs in some families - while in a lot of cases his cause is unknown.

THE FIBRILLATION OF ATRIAL RESULTE

The fibrillation of Atrial has for result:

• An irregular beat that can be too slow, and current of time in time to others.
• The loss of the contraction of atrial that contributes normally to fill with the ventricule (the principal pumping room of the heart) and improves the pump execution -- in certain respects analogous to a surcompresseur of motor of car one.
• The abnormal flow of blood by the atrium with the stagnation sectors (the whirlwinds) that increases the blow risk.

SURGICAL PROCEDURE

The surgical procedure consists creating a number of incisions in the atrium that interromp the circuits of re-participant. Once the incisions are done, they are sewn together again. The atrium can hold then blood on his manner to the ventricule and can squeeze or can contract to push the blood in to the ventricule, but the electric impulse cannot cross the incisions. The result is what seems of a labyrinth of the children in which these there is only a way that the electric impulse can take knot of HIS to the broadcasting knot. The atrium no longer can fibrillate, and the rhythm of sinus (the normal rhythm of the heart) is restored.

INDICATIONS

The procedure of LABYRINTH is not necessary in most of the patients with the fibrillation of atrial. A lot of patients are not bothered by the rhythm or the medicines demanded to check it. In certain cases, the cardiologists can interrupt the circuits with the catheters. Some patients so nevertheless are bothered by the manner they feel when they are in the fibrillation of atrial or by the medicines they must take that a surgical option is fitting. Besides, the individuals in the fibrillation of atrial that tested a blow are at the significant risk for another blow. The procedure of LABYRINTH could be indicated in these individuals also.

CONCLUCIONS

The fibrillations of Atrial are common arrhythmias that arrives in 0,4-5% of adult population and almost 5% of these are not associated with the cardiac disease. It is important to identify the precipitating factor and the eliminates. The anesthedsie can release such arrhythmia.

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