Cases reported "Atrial Fibrillation"

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1/4. Ischemic stroke. Clinical strategies based on mechanisms and risk factors.

    Ischemic stroke is a common disorder associated with significant morbidity and mortality. Results of several pivotal clinical trials completed within the last decade have helped refine stroke prevention and treatment strategies. endarterectomy for symptomatic carotid artery stenosis, anticoagulation in atrial fibrillation, and IV t-PA treatment of hyperacute ischemic stroke may reduce the burden of stroke. Ongoing studies are addressing newly recognized risk factors, such as aortic arch and intracranial atherosclerosis, as well as neuroprotective agents and locally delivered thrombolytics. Successful patient management requires a targeted clinical approach based on vascular localization and risk factor assessment.
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2/4. Antitachycardia pacing therapies and arrhythmia monitoring diagnostics for the treatment of atrial fibrillation.

    The case of a patient with frequent episodes of atrial fibrillation that organizes into atrial flutter following implantation of a dual chamber, rate adaptive pacemaker is reported. The atrial flutter was effectively pace-terminated following activation of the atrial antitachycardia pacing therapies in the pacemaker. This resulted in a decrease in atrial fibrillation burden over time. The present case also illustrates the value of diagnostic data retrieved from pacemakers for monitoring atrial fibrillation frequency over time and evaluating the efficacy of pacing and drug therapy.
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3/4. atrial fibrillation, sleep apnea and obesity.

    BACKGROUND: A 60-year-old male with obesity (body-mass index 43 kg/m(2)) presented with recurrent symptomatic atrial fibrillation (AF), which he had had since age 41 years. The AF was refractory to treatment with antiarrhythmic drugs. Pacemaker implantation for tachycardia-bradycardia syndrome was required as well as ablation for atrial flutter, and the patient underwent a total of four DC cardioversions. sleep studies showed mild to moderate obstructive sleep apnea, but continuous positive airway pressure was not tolerated. Pacemaker interrogations demonstrated mode-switch episodes, indicating continuing AF. He was scheduled for catheter ablation targeting pulmonary vein antral isolation. He embarked on a weight-loss program, which successfully reduced AF burden. INVESTIGATIONS: echocardiography, stress testing, polysomnography, pacemaker interrogations and c-reactive protein. diagnosis: AF, atrial flutter, tachycardia-bradycardia syndrome, obstructive sleep apnea and morbid obesity. MANAGEMENT: Antiarrhythmic drug therapy, DC cardioversion, anticoagulation, atrial flutter ablation, permanent pacemaker implantation, continuous positive airway pressure and weight loss.
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4/4. Pacemaker implantation in a patient with paroxysmal atrial fibrillation and left pneumonectomy.

    Paroxysmal atrial fibrillation is a common occurrence in patients following thoracic surgery and in some patients remains refractory to medical therapy. New pacemaker devices are available with atrial preventative and termination pacing algorithms designed to reduce arrhythmia recurrences. This report describes the implantation of such a device in a patient following pneumonectomy and the subsequent effect on atrial arrhythmia burden.
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