Cardioversion is a medical procedure by which an abnormally fast heart rate ( tachycardia) or other cardiac arrhythmia is converted to a normal rhythm using. Original: Safety of Electrical Cardioversion in Patients With Previous Embolic Events . Cardioversión farmacológica de la fibrilación auricular: ¿flecainida. Paramédico que se respeta shared Gec Tabasco’s video. · January 20, ·. Cardioversión farmacológica -el Dientisto-. Play. Unmute. Enter Fullscreen.
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Cardioversion is a medical procedure by which an abnormally fast heart rate tachycardia or other cardiac arrhythmia is converted to a normal rhythm using electricity or drugs. Synchronized electrical cardioversion uses a therapeutic dose of electric current to the heart at a specific moment in the cardiac cyclerestoring the activity of the electrical conduction system of the heart.
Defibrillation uses a therapeutic dose of electric current to the heart at a random moment in the cardiac cycleand is the most effective resuscitation measure for cardiac arrest associated with ventricular fibrillation and pulseless ventricular tachycardia. To perform synchronized electrical cardioversion, two electrode pads are used or, alternatively, the traditional hand-held “paddles”each comprising a metallic plate which is faced with cardioverzion saline based conductive gel. The pads are placed on the chest of the patient, or one farmacopogica placed on the farmacoloyica and one on the back.
These are connected by cables to a machine which has the combined functions of an ECG display screen and the electrical function of a defibrillator. A synchronizing function either manually operated or automatic allows the cardioverter to deliver a reversion shock, by way of the pads, of a selected amount of electric current over a predefined number of milliseconds at the optimal farmaco,ogica in the cardiac cycle which corresponds to the R wave of the QRS cardioversiom on the ECG.
Timing the shock to the R wave prevents the delivery of the shock during the vulnerable period or relative refractory period of the cardiac cyclewhich could cardiovfrsion ventricular fibrillation.
If the patient is conscious, various drugs are often used to help sedate the patient and make the procedure more tolerable.
However, if the patient is hemodynamically unstable or unconscious, the shock is given immediately upon confirmation of the arrhythmia. When synchronized electrical cardioversion is performed as an elective procedure, the shocks can be performed in conjunction with drug therapy farmadologica sinus rhythm is attained.
After the procedure, the patient is monitored to ensure stability of the sinus rhythm. Synchronized electrical cardioversion is used to treat hemodynamically unstable supraventricular or narrow complex tachycardiasincluding atrial fibrillation and atrial flutter. Carioversion is also used in the emergent treatment of wide complex tachycardias, including ventricular tachycardiawhen a pulse is present.
Pulseless ventricular tachycardia and ventricular fibrillation are treated with unsynchronized shocks referred to as defibrillation. Electrical therapy is inappropriate for sinus tachycardiawhich should always be a part of the differential diagnosis.
Archivo: Fibrilación auricular
Various antiarrhythmic agents can be used to return the heart to normal sinus rhythm. Pharmacological cardioversion is an especially good option in patients with fibrillation of recent onset.
Drugs that are effective at maintaining normal rhythm after electric cardioversion can also be used for pharmacological cardioversion. Drugs like amiodaronediltiazemverapamil and metoprolol are frequently given before cardioversion to decrease the heart rate, stabilize the patient and increase the chance that cardioversion is successful. There are various classes of agents that are most effective for pharmacological cardioversion.
Class Ia slows phase 0 depolarization in the ventricles and increases the absolute refractory period. Procainamidequinidine and disopyramide are Class Ia agents.
Class 1b drugs lengthen phase 3 repolarization.
[Vernakalant in hospital emergency practice: safety and effectiveness].
They include lidocainemexiletine and phenytoin. Class Ic greatly slow phase 0 depolarization in the ventricles however unlike 1a have no effect on the refractory period.
Flecainidemoricizine and propafenone are Class Ic agents. They also decrease cardiac oxygen demand and can prevent cardiac remodeling. Not all beta blockers are the same; some are cardio selective affecting only beta 1 receptors while others are non-selective affecting beta 1 and 2 receptors. Beta blockers that target the beta-1 receptor are called cardio selective because beta-1 is responsible for increasing heart rate; hence a beta blocker will slow the heart rate.
Ibutilide is another Class III agent but has a different mechanism of action acts to promote influx of sodium through slow-sodium channels. It has been shown to be effective in acute cardioversion of recent-onset atrial fibrillation and atrial flutter. Class IV drugs are calcium Ca channel blockers. They work by inhibiting the action potential of the SA and AV nodes. If the patient is stable, adenosine may be administered first, as the medicine performs a sort of “chemical cardioversion” and may stabilize the heart and let it resume normal function on its own without using electricity.
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[Vernakalant in hospital emergency practice: safety and effectiveness].
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