Method for treating atrial fibrillations

FIELD: medicine, cardiology.

SUBSTANCE: along with injecting antiarrhythmic remedy one should introduce varfarin at the dosage of 1-5 mg for 6-8 d followed by a maintenance course in 1-1.5 mo at the dosage of 2-3 mg for 6-7 d and in 2-3 mo at the dosage of 1-2 mg for 5-7 d.

EFFECT: higher efficiency of therapy.

3 ex

 

The invention relates to medicine and can be used in the treatment of atrial fibrillation.

There is a method of treatment of atrial fibrillation by application of cyclic urethanes, taken as the analog of (1).

There is a method of treatment of atrial fibrillation, which has been in use for treatment of drugs: dofetilide, flecainide, amiodarone and other drugs - prototype (2).

However, the use of these drugs, including amiodarone, leads to fibrosis of the lung, paroxysmal ventricular tachycardia, thyroid gland, increasing the level of liver enzymes.

The aim of the invention is to increase efficiency of treatment by reducing side effects of drug therapy.

The technical result is achieved by the fact that in addition to drugs antiarrhythmic actions impose drug warfarin at a dose of 1.0-5.0 mg for 6-8 days followed through 1-1,5 months. supporting course of warfarin at a dose of 2-3 mg for 6-7 days, with subsequent 2-3 month course of warfarin at a dose of 1-2 mg for 5-7 days.

The introduction of the drug warfarin is carried out in doses below therapeutic that reduces symptoms side effects of the drug. On the other hand, the combination of drugs antiarrhythmic actions and warfarin can reduce the RAM drugs antiarrhythmic actions for example quinidine (amiodarone), 1.2 times, and consequently, reduce the appearance pomocnych actions used antiarrhythmic therapy.

The method is as follows.

At admission the patient find out the presence of organic heart disease, particularly involving high electrical activity in the left atrium (stenosis and insufficiency of the mitral valve rheumatic syndrome sick sinus, thyrotoxicosis. Possible idiopathic variants of atrial fibrillation with no evidence of organic heart failure.

Auscultation of suspected atrial fibrillation can be irregular and of different intensity heart rate (delirium cordis). A characteristic symptom is the “pulse deficit” compared with the heart rate.

Electrocardiographically symptoms of atrial fibrillation are:

wave atrial (f) of varying amplitude, morphology and duration without atrial wave P;

irregular ventricular rhythm;

the QRS complexes of normal or aberrant.

The number of contractions of the Atria ranges from 400-700 per min and submitted, f-waves, which are most salient in the right precardiac leads (V 1-V 2), and II, III, aVF-leads. The amplitude of the f-waves can be relatively large (largest is the wave flicker, f-wave greater than 3 mm) and small (melbournejoe flicker). And krupnovesovoe flicker correlates with increased atrium (for example, in congenital heart defects), melbournejoe, prognostically less favorable associated with cardio. Patients perceive frequent abnormal rhythm in atrial fibrillation as painful palpitations or a feeling of discomfort in the chest. Hemodynamic consequences of atrial fibrillation can manifest as weakness, dizziness and shortness of breath.

In atrial fibrillation with a high frequency of contractions observed deeper parabolicheskoi braking (blockage) in the AV connection, in accordance with this, the rhythm of the ventricles will be more rare (less than 60 min) - a bradycardia form flicker. On the contrary, when the low-frequency form of atrial fibrillation atrioventricular connection skips a large number of pulses, resulting develops theoreticheskaya form (more than 100 ventricular contractions per minute), which is often accompanied by signs of refractory heart failure. An intermediate position is epistolica form. In addition, isolated paroxysmal (rare) and permanent (lasting longer than 2 weeks) forms of atrial fibrillation.

For relief of atrial fibrillation in enaut drugs components cardioversion, class 1A, 1C, class II and class III and warfarin at a dose of 1.0-5.0 mg for 6-8 days followed through 1-1,5 months supporting a course of warfarin at a dose of 2-3 mg for 6-7 days, with subsequent 2-3 month course of warfarin at a dose of 1-2 mg for 5-7 days.

Way of the following examples.

Example 1.

Patient K., 43 years old, when receiving complains of palpitations, discomfort in the chest, weakness, dizziness. History of the patient revealed the presence of rheumatic stenosis and insufficiency of the mitral valve.

Auscultation marked irregular and different intensity of heart contractions. A characteristic symptom is the “pulse deficit” compared with the heart rate.

Electrocardiographically there are waves of atrial different amplitude and duration without atrial wave R. the Frequency of contractions of the Atria is 560-700 min and presents f-waves, which are more pronounced in leads V 1-V 2. The amplitude of the f-waves are relatively large, f-wave greater than 3 mm

The patient is prescribed antiarrhythmic drugs of class 1A (procainamide), 1C and class II (β-blockers), and optionally the drug warfarin. With warfarin, used according to the following scheme:

5.0 mg for 8 days, followed by 1 month support ku is com warfarin at a dose of 3 mg for 7 days followed by a 2 month course of warfarin at a dose of 2 mg for 7 days.

As a result of the treatment of atrial fibrillation cropped, which is confirmed by electrocardiographically. Complaints of palpitations, discomfort in the chest does not show. The applied dose of warfarin is 75% of therapeutic, which allowed the number of complications during warfarin treatment. On the other hand, the applied dose arrhythmic funds were also lower than usually prescribed (by 30-40%)that Pospolita to reduce the number of complications arising from the treatment antiaritmikami. Discharged in a state of clinical remission.

Example 2.

Patient S., 37 years old, was admitted with complaints of discomfort in the chest, weakness and shortness of breath. From the anamnesis it is known that the patient is suffering from myocarditis. During the examination the patient looks pale; heart size increased; blood pressure is reduced, and the pulse Ochsen.

Auscultation also noted the presence of irregular intensity heart rate, characteristic of atrial fibrillation. Marked “pulse deficit” compared with the heart rate.

Electrocardiographically identified: the absence of atrial, and P wave and wave-atrial (f) of varying amplitude, morphology and duration, most pronounced in II, III and aVF-leads. The number is krasheny fibrillation varies between 400-550 in minutes

Patient prescribed drugs class 1A (quinidine), as well as voltaren and warfarin. And warfarin take on the following diagram:

at a dose of 1.0 mg for 6 days, followed in 1.5 months. supporting course of warfarin at a dose of 2 mg for 6 days, followed after 3 month course of warfarin at a dose of 1 mg for 5 days.

As a result of the treatment of atrial fibrillation cropped, which is confirmed by electrocardiographically. Complaints of discomfort in the chest, weakness does not show. The use of complex therapy with antiarrhythmic drugs number and warfarin reduced dose as antiaritmikov, and warfarin, which allowed to reduce the dose and the number of oslojenni medicamentous therapy. Discharged in a state of clinical remission.

Example 3.

Patient 3., 56 years old, when he complained about painful palpitations, dizziness and shortness of breath. History of the signs of organic disease of the heart is not marked.

Auscultation is an irregular and different intensity of heart contractions delirium cordis).

Electrocardiographically there are waves of atrial varying amplitude, irregular ventricular rhythm. The number of contractions of the Atria ranges 560-640 min and presents f-waves, which are more pronounced in the right precardiac otede is s (V 1-V 2), and the amplitude of f-waves is relatively small (melbournejoe flicker).

The patient is prescribed the drug amiodarone and warfarin. And warfarin take the following scheme: at a dose of 3.0 mg for 7 days, followed after 5 weeks of maintenance rate of warfarin at a dose of 2.5 mg for 6 days, followed after 2.5 month course of warfarin at a dose of 1.5 mg for 6 days.

The result of the treatment is reduction of atrial fibrillation. Complaints of palpitations, dizziness and shortness of breath does not show. Discharged in a state of clinical remission.

The treatment according to the claimed method 31 of the patient. The mentioned combination of warfarin and antiarrhythmic drugs with the stated combination of low doses ensures the achievement of the technical result in the exclusion of the manifestations of the side effects of the applied drug therapy. Follow-up monitoring within 6-12 months. found no recurrence of atrial fibrillation in all the examined patients.

Sources of information

1. RF patent №2125568.

2. J. Am. Coll. Cardiol. 2001; 38:1266.

A method of treating atrial fibrillation by introducing antiarrhythmic drugs, characterized in that it further impose warfarin at a dose of 1.0-5.0 mg for 6-8 days followed through 1-1,5 months. supporting course of warfarin at a dose of 2-3 mg in those who tell 6-7 days with the next 2-3 months. the rate of warfarin at a dose of 1-2 mg for 5-7 days.



 

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