[AF-FORUM] 119E 急诊室房颤的心律控制，以及次日的治疗 Dr. Vega Adauy

[AF Symposium]

感谢大会提供这么好地交换知识的机会。

问题：在急诊情况下，对于房颤伴快心室率而又没有 
急诊电复律指正的患者，器质性心脏病基础不明，哪 
种药物对心室率控制首选（患者没有慢性阻塞性肺病 
等等）？（药物中应该除外Diltiazem，因为我们国家没 
有注射剂型。）心律平？Lanatoside C？安碘酮?(避免应 
用？还是最后的选择？)

2．在同样情况下，安碘酮可以连续注射24小时直到地 
高辛+倍他阻滞剂起效吗？这种方法产生转律进而带 
来的风险有多大（在慢性房颤患者）。我以这一问题 
是因为，我经常看到有些医生安碘酮静推后连续静脉 
维持24小时，而地高辛+阿替洛尔（可以用卡维地洛更 
换？）第二天才给予。

3．在心衰患者合并重症肾衰（地高辛禁用），对于 
控制心室率倍他阻滞剂可以单独应用吗？这一办法到 
底效用如何？

谢谢

Julián Vega Adauy, Med Intern
Los Angeles, 智利

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119E A-Fib Tach RATE control in ER and the next day. Dr. Vega Adauy

Thanks for making this incredible knlowledge exchange possible.

Q: In the Emergency Room setting, in patients arribing with a clear A-
Fib Tach (irregular+narrow QRS) with no indication for inmediate CV,  
with
unknown structural heart disease, wich is the best option for rate  
control?
(in the abscence of COPD or other..) and excluding Diltiazem -not  
available
in amps for i.v infussion in my Country-. Propanolol?, Lanatoside C,  
(Amiodarone
--> should be avoided? last option?)

2. In the same setting, Can AMIODARONE be use in continous inffusion
to control RATE (not rythm) for the first 24h until Digoxine+BB is  
initiated.
Wich is the risk for conversion to sinus with this aproach. (in  
Chronic AF
setting).

I ask this, because I had seen many times, that for RATE control (yes
Rate) AMIODARONE bolus + Continous Inffusion is given until Digoxin and
ATENOLOL (can be used instead of Carvedilol??) is given the next day.

3. In patients with structural heart disease with advanced Renal Disease
(that can't use Digoxin), to control RATE can B-Blockade be indicated
alone? how usefull is this approach?.

Thanks again
Sincerely

Julián Vega Adauy, Med Intern
Los Angeles, CHILE

--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee