Management of Atrial Fibrillation

The human heart is a muscular pump which beats as a result of electrical impulses produced by a special group of cells in the heart that have the ability to generate electrical activity on their own. Any abnormalities in the heart rate or rhythm can be considered to be a fault in the electrical conduction system of the heart. If the heart rate remains constantly slower (bradycardia) or faster (tachycardia) with irregular rhythm, then it may be a heart condition called arrhythmia. Diagnosis of arrhythmia involves collecting information about symptoms, evaluating medical history and a physical exam. Electrocardiogram, cardio monitoring and blood flow blood pressure measurements are some of the diagnostic tests, blood pressure and procedures performed to identify the underlying cause of abnormal heart rhythms.

Atrial fibrillation or A-fib (AF) is a type of arrhythmia that happens when the electrical signals are not only generated from sinus node, but are also generated from different places in and around the right atrium. When the atrioventricular node (AV node) – the electrical relay station between the upp and lower chambers of the heart-- is flooded with multiple erratic signals  it leads to twitching of atria and desynchronised contractions of heart chambers. There are mainly three types of atrial fibrillation - Paroxysmal Atrial Fibrillation, Persistent Atrial Fibrillation and Permanent Atrial Fibrillation. Whenever the A-fib lasts from a few seconds to about a week, it is termed as Paroxysmal Atrial Fibrillation and when the A-fib episode continues for more than seven days, the condition is called persistent atrial fibrillation. When the abnormal heart rhythm persists all the time, it is called permanent atrial fibrillation. Both the paroxysmal and persistent AF can progress to permanent AF over a period of time, which is why it is highly recommended to seek treatment as early as possible.  

AF episodes cause a disruption in the blood flow thereby increasing the likelihood of blood clot formation.  That is why risk of acute cardiovascular events and strokes are higher among people with atrial fibrillation. Treatment of Afib aims in cutting down the risk of blood clot formation and restoring the normal heart rhythm. Medical therapy using anticoagulants and electrical interventions are performed to treat this heart condition. Electro cardioversion, catheter ablation and surgical pocket maze are the standard procedures opted by the cardiologists to treat arrhythmias. In some cases, ablate and pace approach is recommended. During this procedure, the AV node is destroyed and an artificial pacemaker is placed in the surgical pocket of the chest to ensure a regular backup rhythm. Choosing between pharmacological treatment and ablation procedures always comes down to factors such as degree of AF episodes, cardio health and evaluation of surgical complications.

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Why Diagnosis of Treatment Resistant Hypertension is Important?

It is a well known fact that heart diseases have been claiming the lives of people more than any other disease. Termed as Coronary Heart Disease, this cardiac condition leads to heart attack, stroke and other major cardiovascular events. Treatment of coronary heart disease mainly focuses on controlling the risk factors by making lifestyle changes and prescribing drug treatments. High blood pressure (hypertension) and high blood cholesterol levels are the biggest risk factors that need to be brought under control. Several studies, clinical trials and research findings have stated that patients with resistant hypertension are even at higher risk of cardiovascular morbidity, stroke and mortality. Treatment resistant hypertension is a medical condition when the blood pressure remains stubbornly above the target in spite of the use of a diuretic and at least two other medications; patients whose blood pressure is controlled by four or more medications can be termed as resistant to treatment.

Accurate diagnosis and effective use of multiple drug regimens is significant in order to tackle treatment resistant hypertension. The goal blood pressure is less than 140/90 mmHg and achieving this level is even more important among resistant hypertension patients as it is associated with worse cardiovascular events. Taking accurate measurements of blood flow blood pressure is substantial for confirming treatment resistance. Direct (invasive) and indirect (non-invasive) methods are available for measuring the blood pressure and blood flow. Direct method involves using intra-arterial catheter to puncture a blood vessel and taking measurements directly, whereas the non-invasive method is about measuring the arterial pressure indirectly with a manual sphygmomanometer or an automated oscillometric device.

Physicians often prefer the indirect method because it’s the ‘gold standard’ method for routine measurements and monitoring. However, the accuracy levels of indirect measurements are low when compared to the direct methods. That is why it is important to have a hemodynamic monitoring system especially during the invasive procedures. Xper Flex Cardio physiomonitoring system introduced by Philips Healthcare is an innovative step towards this direction. It not only displays the invasive blood pressure blood flow, but also Fractional Flow Reserve measurements, ECG, respiration and other vital signs. Xper Flex Cardio systems prove to be of great use in areas where hemodynamic cardiac monitoring is required. To return to the subject of treatment resistant hypertension, we can say that ruling out the pseudoresistance factors and identification of the true causes can help in devising an effective prevention and management strategy of this condition.

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