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| 2. |
- Meurling, Carl, et al.
(författare)
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Attenuation of electrical remodelling in chronic atrial fibrillation following oral treatment with verapamil
- 1999
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Ingår i: Europace. - : Oxford University Press (OUP). - 1532-2092 .- 1099-5129. ; 1:4, s. 234-241
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Electrical remodelling with shortening of the atrial refractory period and increased fibrillatory rate occurs after onset of atrial fibrillation and can be attenuated by pre-treatment with intravenous verapamil. The aim of the present study was to investigate whether already established fibrillatory-induced shortening of atrial fibrillatory cycle length could be reversed with oral verapamil. METHODS AND RESULTS: Thirteen patients (nine men; mean age 67 years) with chronic atrial fibrillation (CAF) were studied. The dominant atrial cycle length (DACL) was estimated non-invasively using the frequency analysis of fibrillatory ECG (FAF-ECG) method. Measurements were repeated following treatment with slow release oral verapamil. DACL increased from 147 +/- 13 ms to 156 +/- 21 ms after 1 day (P=0.02), to 164 +/- 18 ms after 5 days (P=0.005) and finally to 160 +/- 16 ms after 6 weeks (P=0.008). CONCLUSION: Long-term oral treatment with verapamil increases the DACL significantly in patients with CAF. The prolongation is evident after 1 day and is further developed during the first 5 days of treatment. Since DACL is believed to be an index of refractoriness, the findings of the present study suggest that this treatment increases the atrial refractory period in patients with CAF.
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| 3. |
- Olsson, Bertil
(författare)
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Atrial fibrillation and flutter: aeromedical considerations. New strategies for management and intervention
- 1999
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Ingår i: European Heart Journal Supplements. - 1520-765X. ; 1:Suppl. D, s. 94-97
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Tidskriftsartikel (refereegranskat)abstract
- Few cases of atrial fibrillation can be completely excused from the possibility of having some impact of potential importance in the aviation environment. The clinical pattern in paroxysmal disturbance is very wide and possible incapacitating phenomena are mainly haemodynamic. In contrast, chronic atrial fibrillation is mostly well-tolerated with only minimal haemodynamic effect, but there is a risk of thromboembolism, suggesting the need for anti-thromboembolic treatment. A subgroup with chronic atrial fibrillation with a very low risk may be defined, allowing avoidance of anti-thromboembolic treatment and a positive attitude towards aeromedical certification. Such individuals are likely to be normotensive males, under the age of 60 years, with a normal left (and right) heart configuration on electrocardiography.
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| 6. |
- Olsson, Bertil
(författare)
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Förmaksflimmer--epidemiologiska och elektrofysiologiska aspekter
- 1999
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Ingår i: Tidsskrift for Den Norske Lægeforening. - 0029-2001. ; 119:11, s. 1601-1604
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Tidskriftsartikel (refereegranskat)abstract
- Atrial fibrillation is a common and therapy-requiring cardiac arrhythmia. The chronic form becomes identified in population studies from the age of 50 and increases with age. The number of Norwegian individuals with this arrhythmia is estimated to be slightly in excess of 40,000 and it will increase approximately by another 5,000 until the year 2010. Mechanisms responsible for initiation and maintenance of the arrhythmia are increasingly better understood. The paroxysmal form often has a focal origin, allowing curative treatment, but can also be associated with signs of deficient interatrial conduction. The chronic form is perpetuated partly by a shortening of atrial myocardial refractoriness, attributed to a failure in the intracellular turnover of Ca-ions due to the high excitation rate. Ongoing studies are expected to illustrate the clinical benefit of Ca-blockers prior to cardioversion of chronic atrial fibrillation. The further relapse rate is low in patients who have maintained sinus rhythm more than 1-2 months following conversion. It is therefore possible that, following a successful conversion to sinus rhythm, aggressive antiarrhythmic treatment should be given during a limited period only--a strategy which has to be evaluated in prospective studies.
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| 7. |
- Olsson, Bertil, et al.
(författare)
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Förmaksflimmer - ny kunskap ger nya behandlingsmöjligheter
- 1999
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Ingår i: Läkartidningen. - 0023-7205. ; 96:36, s. 3796-3803
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Tidskriftsartikel (refereegranskat)abstract
- Atrial fibrillation (AF) is the most common cardiac arrhythmia prompting treatment. Advances in our knowledge of the pathophysiology of AF provide the basis for new and improved treatment modalities. Thus, focal excitation and localised impulse conduction defects are possible trigger factors which can be counteracted by focal ablation and pacing synchronisation, respectively. Perpetuation of AF, caused by continuous multisite re-entry, is promoted by successive shortening of repolarisation. Internal defibrillation and anatomical limitation of re-entry are treatments that counteract perpetuation of the arrhythmia. Current knowledge of AF and the application of new treatments are discussed by the Lund AF research group.
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| 9. |
- Pehrson, Steen, et al.
(författare)
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The optimal oesophageal pacing technique--the importance of body position, interelectrode spacing, electrode surface area, pacing waveform and intra-oesophageal local anaesthesia
- 1999
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1651-2006 .- 1401-7431. ; 33:2, s. 103-109
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Tidskriftsartikel (refereegranskat)abstract
- In order to improve the technique of transoesophageal atrial stimulation (TAS), the effects of body position, interelectrode spacing and electrode surface area on pacing threshold were assessed in two substudies. The effects of intra-oesophageal local anaesthesia and of two different pacing wave configurations on pacing threshold and discomfort were also assessed. Substudy I comprised 16 subjects (3 patients with a history of paroxysmal supraventricular tachycardia and 13 healthy volunteers) and substudy II comprised 16 healthy volunteers. TAS was performed using a hexapolar luminal prototype oesophageal electrode catheter. In substudy I bipolar pacing was performed in the semi-supine and left decubitus body positions for different pulse durations (20, 10, 6 and 2 ms), interelectrode pole distances (10 to 24 mm) and electrode pole surface areas (0.22 to 0.66 cm2). In substudy II TAS was performed with square wave and triangular waveform pulses after intra-oesophageal saline and lidocaine 20 mg/ml. These solutions were given in random order. Neither the interelectrode distance nor electrode surface areas had any significant influence on pacing thresholds. Stimulation thresholds were not affected by body position. Intraoesophageal lidocaine did not affect the discomfort experienced. Peak pacing thresholds using a triangular waveform were significantly higher than thresholds using a square waveformn (p < 0.001). The optimal pacing technique for TAS remains to be defined. The TAS-induced pain is probably not generated from the oesophageal mucous membrane. There is a significant difference in pacing thresholds between triangular and square waveforms.
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