Različite strategije liječenja atrijske fibrilacije

master's thesis

• Title (english): Treatment strategies for atrial fibrillation
• Author: Paško Petrović
• Mentor: Mislav Puljević (mentor)
• Committee member: Davor Puljević (predsjednik povjerenstva)
• Committee member: Martina Lovrić Benčić (član povjerenstva)
• Committee member: Mislav Puljević (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2017-07-14, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Atrijska fibrilacija je najučestalija postojana srčana aritmija te značajan uzrok kardiovaskularnog pobola i smrtnosti diljem svijeta. Prisutna je u preko 33 milijuna ljudi, kojima često donosi veliko simptomatsko opterećenje te povišen rizik od značajnih tromboembolijskih komplikacija, prije svega od moždanog udara. Upravo su ovo dva glavna aspekta prema kojima se usmjerava strukturirano i interdisciplinarno liječenje fibrilacije atrija, već od njenog prvog nastupa. Tako u akutnom zbrinjavanju ove aritmije odlučujemo o potrebi i načinu prevođenja u sinus ritam, imajući na umu stabilnost pacijenta, ali i zahtjeve za prikladnom antikoagulacijom. Oralna antikoagulantna terapija također je i temeljna strategija dugoročnog liječenja fibrilacije atrija, zahvaljujući povoljnom utjecaju na prognozu bolesti. U ovom pogledu danas se može izabrati između starijih lijekova, antagonista vitamina K te novijih antikoagulantnih lijekova; nakon što smo pažljivo odvagnuli prednosti i mane jednih i drugih. Sljedeći je pristup terapiji fibrilacije umanjivanje ili uklanjanje pacijentovih tegoba, gdje predstoji odabir između dvije strategije, kontrole frekvencije i kontrole ritma. Konačna odluka o strategiji liječenja atrijske fibrilacije treba biti temeljena na novijim znanstvenim spoznajama, ali i individualna: uzimajući u obzir karakteristike i želje pacijenta, prednosti i nedostatke pojedine terapije.

Abstract (english)

Atrial fibrillation is the most common sustained arrhythmia, and a significant cause of cardiovascular morbidity and mortality throughout the world. It affects over 33 million people, in terms of great symptomatic burden and increased risk of thromboembolic complications, mainly stroke. These are the two aspects that guide a structured and interdisciplinary approach to treatment of atrial fibrillation, starting from its first onset. Accordingly, in acute management of this arrhythmia, a decision must be made on the need and the means of cardioversion, having in mind hemodynamic stability of the patient and possible requirements for anticoagulation. Oral anticoagulant therapy is also an essential strategy for long-term management of atrial fibrillation, on account of considerably improved outcomes of the disease. In this regard, there is a choice between vitamin K antagonists and novel anticoagulants, which depends on a carefull assessment of the risks and benefits of each option. Subsequent approach to atrial fibrillation treatment is aimed at reducing or eliminating patient's symptoms, deciding between two main strategies, rate control and rhythm control. The final decision on the strategy of atrial fibrillation management should be based on recent scientific knowledge, but also reached individually: taking into consideration the characteristics of the patient, advantages and disadvantages of each therapy.

• Keywords: atrijska fibrilacija; liječenje; prevencija moždanog udara; kontrola ritma; kontrola frekvencije
• Keywords (english): atrial fibrillation; treatment; stroke prevention; rhythm control; rate control
• Language: croatian
• URN:NBN: urn:nbn:hr:105:074457
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2018-03-15 14:01:07