ATRIAL FIBRILLATION

Atrial Fibrillation

Abstract

The association of atrial fibrillation with thoracic surgical procedures is well known, but nevertheless its cause is not well defined. Increased sympathetic activity may playa role in the development of atrial fibrillation, and reduced l3-receptor activity may be advantageous. The objective was to evaluate the effect of oraf B-blockade on the frequency of atrial fibrillation and to evaluate some possible causative factors. The study was prospective, randomized, and double-blind, and was conducted at Aarhus University Hospital. Thirty patients without previous or present cardiovascular history undergoing elective thoracotomy for lung resection. The patients received either 100 mg of metoprolol or placebo orally before surgery and once daily postoperatively. Anesthesia consisted of a thoracic epidural block combined with general intravenous anesthesia. Epidural morphine was continued postoperatively. The significant association of arrhythmias, especially atrial fibrillation (AF), with thoracic surgical procedures has been established in many reports.l' Nevertheless its cause remains poorly defined, although several factors are likely to playa part.

Because the development of atrial fibrillation is the most common cardiac complication of thoracic surgery, it has been recommended that digoxin be given prophylactically.v-? However, controversy exists regarding its effectiveness, because newer studies have not established any prophylactic effect.S-1O Sympathetic effects on the heart are mediated through f3-receptors, and their stimulation results in increased excitability and automaticity, Presuming that increased sympathetic activity plays a role in the development of atrial fibrillation, reduced peri operative f3-receptor activity may be advantageous, Several studies have found that f3-blockade may reduce arrhythmias during noncardiac surgery,'!'!" and although the effect on plasma catecholamine levels seems to be inconclusive,II attenuation of the cardiovascular effects resulting from different types of peri operative stimuli has been demonstrated. The current study was designed to evaluate the effect of oral f3-blockade on the frequency of peri operative atrial fibrillation after thoracotomy for lung resection in patients with presumed high risk for developing atrial fibrillation, and to evaluate some causative factors.

Table of Content

ABSTRACTII

CHAPTER 01: INTRODUCTION1

Background of the Research1

Purpose of the Research1

Problem Statement1

CHAPTER 02:LITERATURE REVIEW3

Perioperative Metoprolol3

Comparing Ablation And Anti-Arrhythmic Drug3

Sinus Rhythm: A Worthy Quest?4

Anti-Arrhythmic Drugs5

Atrial fibrillation ablation: rationale6

CHAPTER 03: LITERATURE CRITIQUE7

Critical Appraisal Skills Programme (CASP) of Atrail Fibrillation7

Strategies for atrial fibrillation catheter ablation7

Ablation for paroxysmal atrial fibrillation9

Ablation for persistent atrial fibrillation9

Ablation vs. drugs studies10

Atrial fibrillation ablation in patients with heart failure11

Adverse events12

Health economy13

Limitations14

CHAPTER 04: METHODOLOGY20

Research Design20

Primary or secondary / Qualitative or Quantitative20

Mixed Method Research20

Statistically Analysis23

CHAPTER 05: THE REVIEW NARRATIVE30

Perioperative Metoprolol32

CHAPTER 06: CONCLUSION AND IMPLICATION40

ANNOTATED BIBLIOGRAPHY : ARTICLE44

REFERENCES52

CHAPTER 01: INTRODUCTION

Background of the Research

Age, height, and weight of each patient were recorded along with details of current medications. Preoperative systolic, diastolic, and mean arterial pressures together with heart rate were measured by a noninvasive oscillometric method (Dinamap), (Jens Eckstein 2008 435)The patients' preoperative pulmonary status, expressed as the percentage of predicted values of forced expiratory volume in the first second, vital capacity, and functional vital capacity, together with arterial blood gases, were done less than 3 weeks before surgery,

Purpose of the Research

An epidural catheter was inserted in the thoracic region between T 4 ...