Из 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Цитата:
11.1.3 Electrical cardioversion
Synchronized direct current electrical cardioversion quickly and effectively converts AF to sinus rhythm, and is the method of choice in severely haemodynamically compromised patients with new-onset AF (Figure 16).626–628 Electrical cardioversion can be performed safely in sedated patients treated with intravenous midazolam and/or propofol. Continuous monitoring of blood pressure and oximetry during the procedure is important.629 Skin burns may occasionally be observed. Intravenous atropine or isoproterenol, or temporary transcutaneous pacing, should be available to mitigate post-cardioversion bradycardia. Biphasic defibrillators are more effective than monophasic waveforms, and have become the industry standard.626,628 Anterior–posterior electrode positions generate a stronger shock field in the left atrium than anterolaterally positioned electrodes, and restore sinus rhythm more effectively.626,627,630
Pre-treatment with amiodarone (requiring a few weeks of therapy),631,632 sotalol,631 ibutilide,633 or vernakalant634 can improve the efficacy of electrical cardioversion, and similar effects are likely for flecainide584 and propafenone.635 Beta-blockers,636 verapamil, diltiazem,637–639 and digoxin640,641 do not reliably terminate AF or facilitate electrical cardioversion. When antiarrhythmic drug therapy is planned to maintain sinus rhythm after cardioversion, it seems prudent to start therapy 1–3 days before cardioversion (amiodarone: a few weeks) to promote pharmacological conversion and to achieve effective drug levels.584,601
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Несколько недель амиодарона до ЭИТ улучшают эффективность. После продолжать не обязательно, т.к. препарат долго выводится.
Важно сделать ЭКГ до и через неделю от начала его приема. Нужно смотреть, чтобы QTc не увеличился больше 500 мс.
За пару недель приема ничего он не расстроит. Наоборот, многие даже субъективно чувствуют себя лучше на фоне его приема. Изобретался амиодарон как противоишемический препарат, а не как антиаритмик.
05.12.2018, 18:30
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