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2017년  10월30일자 자료중에서                          http://a-fib.com/steves-a-fib-blog/

Don’t Just ‘Manage’ Your A-Fib. 당신의 심방세동을 단순히 관리하지 마셔요

Learn All Your Treatment Options. 치료선택방법을 공부하셔요

Aim for a Cure.                                             치료를 목표로 하셔요

“Get your A-Fib taken care of. 심방세동이 보살핌을 받도록 하셔요

It won’t go away. 사라지지 않습니다,

It may seem to get better, 좋아질 수도 있습니다.

but it will return. 그러나 다시 재발합니다

Don’t think that the medication is long term solution.” 약물치료가 장기적인 해결책으 로 생각하지마셔요

Danel Doane,

A-Fib free after Mini-Maze surgery.       심방세동은 Mini-Maze surgery후 치료됩니다.

                                ( 전극도자절제술 )

Don’t Expect Miracles from Current Medications.     현재의 약물치료로 기적을 기대하지 마셔요

Antiarrhythmic drugs are only effective for about 40% of patients.

                                                                       부정맥약은 환자의 40%만이 효과를 봅니다

Many patients can’t tolerate the bad side effects. 많은 환자는 약의 부작용을 견디지 못합니다

When drugs do work, over time, they become less effective or stop working.

                                                                약효과 있다가 시간이 지나면 약효가 떨어지거나 듣지 않습니다.

According to Drs. Savelieva and Camm:  

“The plethora of antiarrhythmic drugs currently available for the treatment of A-Fib is a reflection that none is wholly satisfactory, each having limited efficacy combined with poor safety and tolerability.”

심방세동관리로 현재 쓰이는 부정맥약이 많다는 것은

어느 것도 완전히 만족스럽지 못함을 반증하는 것이지요

Drugs don’t cure A-Fib but merely keep it at bay.

약은 치료하지 못하고 단지 (증세를) 사라지게 할 뿐입니다

Learn All Your Treatment Options 치료선택방법을 공부하셔요

Educate yourself about all your treatment options,  

Finally, discuss these treatment options with your doctor. This should be a ‘team effort’, a decision you and your doctor will make together.

치료선택방법을 스스로에게 교육시키셔요.

마지막으로 의사선생님과 치료선택방법을 의논하셔요.

이런 것이 당신과 의사선생님과 함께 만들어 가는 “팀노력”이고 결정이 되겠지요

Don’t just ‘manage’ your A-Fib. Seek your Cure.

심방세동을 관리하지 마시고, 치료되기를 바라셔요.

우리나라 의료시스템과 달라 미국자료인용에 한계가 있지만  공유해봅니다.

잘못된 해석이 있을 수 있어서 영어 원문도 함께 했읍니다  

치료선택방법은  영문전체를 올리고

해당싸이트를  링크시킵니다.

영어 잘 하시는 분 계시면  해석해서 올려 주시면 고맙겠읍니다!!!!!!!

http://a-fib.com/treatments-for-atrial-fibrillation/decisions-about-treatment-options/

Decisions About Treatment Options

Decisions About A-Fib Treatment Options

Which of the A-Fib Treatment Options is Best for Me?

Choosing from the Atrial Fibrillation treatment options is a decision only you and your doctor can make. But depending on the type of A-Fib you have, here are some guidelines which may help you. Listed below are A-Fib conditions as described by those with A-Fib. Select one (or more) that best describes your A-Fib and read your possible options.

1. “My A-Fib just started.”
2. “My A-Fib is occasional (Paroxysmal) with no or mild symptoms (sometimes referred to as “silent’ A-Fib).”
3. “I have infrequent, short episodes of symptomatic A-Fib.”
4. “I have Paroxysmal (occasional) A-Fib but am in good health overall.”
5. “I have Paroxysmal (occasional) A-Fib but also have serious heart and/or other health problems.”
6. “My A-Fib is Persistent or Chronic (all-the-time).”
7. “I have Persistent or Chronic (all-the-time) A-Fib but no symptoms (‘silent’) A-Fib.”
8. “I have A-Fib but am allergic to Coumadin, Heparin, Lovenox and most blood thinners. I’m also very overweight. And I’ve already had one stroke.
9. “I’ve had two failed left atrium ablations and have tried many different medications.”

---

 1.   “My A-Fib just started.” 

You might be helped by a Electrical Cardioversion and/or Chemical Cardioversion. Doctors can perhaps shock your heart back to beating normally.

VIDEO of Electrical Cardioversion: Observe the ease and safety an of actual procedure on Dr. Bruce Janiak recorded by his ER staff. Go to video->

Antiarrhythmic meds may also be used for several months to train your heart to stay in normal sinus rhythm. Ideally after cardioversion, your heart won’t go back into A-Fib. But don’t delay. This treatment seems to work best in cases of recent onset A-Fib. The main problem with Electrical Cardioversions is they often don’t last very long. 

2.   “I have occasional (Paroxysmal) A-Fib with no or mild symptoms (sometimes referred to as “silent‘ A-Fib).”

Doctors may have discovered you had A-Fib during a routine examination, but you weren’t aware of anything wrong and feel generally OK.

Since you’ve probably had A-Fib for a while, an Electrical Cardioversion may not have as good a chance of getting you back into normal sinus rhythm. But it might be worth trying.

Another option might be to just live with the A-Fib, since it doesn’t seem to affect you very much. You still need to talk with your doctor about whether or not you should be on blood thinners, since with “silent” A-Fib you are at risk of an A-Fib stroke. Your doctor may also prescribe Rate Control medications to make sure your heart doesn’t beat too fast.

However, this option of just living with A-Fib may eventually cause you problems. A-Fib is a progressive disease that tends to get worse. Your episodes become longer and more frequent. You are at greater risk of stroke and heart failure. You may feel more pounding or fluttering in your chest. Because blood isn’t being pumped properly to your body and brain, you may feel more tired and listless. You may experience more shortness of breath, weakness, chest pain, fatigue, dizziness or fainting. You may not be able to think properly. Over time A-Fib tends to stretch and weaken the heart often leading to other heart problems and heart failure.¹ An enlarged atrium (approximately over 55 mm) may limit your options. Some centers won’t accept patients for a PVA(I) procedure if they have an enlarged heart, because the heart walls have been stretched thin and are easily perforated and burnt through by an RF ablation catheter.

Also, A-Fib over time may lead to decreased mental abilities and even dementia, because blood isn’t being pumped properly to the brain and other organs.

If you choose the option of just living with your A-Fib, it is important to monitor you closely; for example, your atria should be measured periodically to see if they are being stretched and enlarged, and your cognitive abilities should be tracked over time. But you may be able to live for years with occasional “silent” A-Fib episodes which don’t progress to anything worse.

The use of antiarrhythmic medications with their risk of bad side effects may not be justified when your A-Fib is “silent” and infrequent. The same holds for a Pulmonary Vein Ablation (Isolation) procedure. (Many doctors won’t perform a PVA(I) on someone relatively A-Fib symptom free.)

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3.   “I have infrequent, short episodes of symptomatic A-Fib.”

An Electrical Cardioversion might be worth trying, though it generally has the best chance of success with early onset A-Fib.

The option of just learning to live with your A-Fib may not be acceptable to you, depending on how bad your A-Fib symptoms are. Not only do you have to deal with the A-Fib symptoms, but also with the psychological trauma and fear of knowing an A-Fib attack is always possible.

Since your A-Fib episodes are relatively infrequent, antiarrhythmic meds may keep your heart in normal sinus rhythm. But watch out for bad side effects. There is a fine line between giving your body time to adjust to the antiarrhythmic med, and recognizing that the medication is causing you unacceptable side effects.

Some people have had success with antiarrhythmic drugs flecainide (brand name Tambocor) or the newer meds dofetilide (Tikosyn) and Rhythmol SR.

Because your symptoms are infrequent, you may have a simpler, more easily fixed type of A-Fib; i.e., your A-Fib may come from only one or two spots in the heart which a Pulmonary Vein Ablation (Isolation) has a good chance of curing. However, many doctors and medical centers are hesitant to perform a PVA(I) on someone with relatively infrequent A-Fib episodes. You may have to be assertive. But current guidelines give you the right of choosing to have a PVI rqather than having to spend time trying various antiarrhythmic drugs.

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4.   “I have Paroxysmal (occasional) A-Fib but am in good health overall.”

An Electrical Cardioversion may be effective for you, though it generally has the best chance of success with early onset A-Fib.

Antiarrhythmic meds may help in the short term, but they tend to lose their effectiveness over time. In general, don’t expect an antiarrhythmic med to be a permanent cure for your A-Fib.

You have perhaps the best odds of being cured by a Pulmonary Vein Ablation (Isolation) procedure. Doctors may use both Electrical Cardioversion and Chemical Cardioversion during and after a PVA(I) to help your heart stay in normal sinus rhythm.

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5.   “I have Paroxysmal (occasional) A-Fib but also have serious heart and/or other health problems.”

An Electrical Cardioversion may not be an option for you, depending on your other heart and/or health problems.

The antiarrhythmic Class III drugs Sotatol, Dofetilide, and Azimilide appear to be safer to use if you have structural heart disease.² Amiodarone is also a Class III drug, but it often has more serious bad side effects even though it is probably the most effective antiarrhythmic med. (See Drug Treatments for more info.)

A PVA(I) can  be very effective; however, you need to prioritize and take care of your most serious heart and health problems first. A successful PVA(I) may improve your overall heart functions such as ejection fraction.

If your heart problems require surgery, you may want to consider going to a surgeon who can perform a Maze operation at the same time.

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6.   “I have Persistent or Chronic (all-the-time) A-Fib.”

People with Persistent or Chronic A-Fib often have more than one or two spots in the heart producing A-Fib signals. These A-Fib signal sources often have gotten stronger over time and are less likely to be affected by Electrical Cardioversion. Antiarrhythmic meds may also be less effective.

Until recently your chances of being cured of Chronic A-Fib by a PVA(I) were less than if you had Paroxysmal (occasional) A-Fib. Doctors have to work harder to find and ablate the many A-Fib signal sources often found in Chronic A-Fib patients. Some centers have rules such as not accepting patients who have had Chronic A-Fib for over a year. However, a study by the French Bordeaux group reported a 95% success rate in curing Chronic A-Fib after two ablation procedures.³

If you have Chronic A-Fib, you have to be prepared to have at least two ablation procedures.

People with Chronic long-standing A-Fib were generally thought not to benefit from a Maze operation such as the Radial Maze. But recent developments in the Maze operation offer new hope to Chronic A-Fib-ers.⁴

The Mini-Maze operations probably aren’t a satisfactory option if you have Chronic A-Fib, since they currently can’t reach or block all areas of the heart where A-Fib signals are found.

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7.   “I have Persistent or Chronic (all-the-time) A-Fib but no symptoms (‘silent’) A-Fib.”

You may want to consider just learning to live with the A-Fib. You will have to be on blood thinners or have a Watchman device installed to keep from having an A-Fib stroke. You will probably have to take rate control meds to keep your heart from beating too fast. Your heart isn’t pumping out properly, but you can compensate to some extent by exercise. You may be able to lead a close-to-normal life in silent Chronic A-Fib. It’s hard to justify the effort and risk necessary to fix Chronic A-Fib if you have no A-Fib symptoms.

Chronic A-Fib is harder to fix and often requires at least two ablations. An unintended consequence of a successful ablation for Chronic A-Fib is your A-Fib may be improved so that you are only Paroxysmal (occasional). But Paroxysmal A-Fib may be more debilitating and troublesome than being in Chronic A-Fib. At least in Chronic A-Fib you don’t have to worry about having an A-Fib attack.

A Cox Radial Maze to fix Chronic A-Fib is open heart surgery which is very traumatic and risky. It’s hard to justify open heart surgery if you’re feeling OK. The Mini-Maze operations probably aren’t a satisfactory option if you have Chronic A-Fib, since they currently can’t reach or block all areas of the heart where A-Fib signals are found.

Another factor to consider is your age. If you’re 40 years old, it’s probably worth the effort to get your silent Chronic A-Fib fixed. Chronic A-Fib over time will probably damage your heart, brain, and other organs. But if you’re in your 70s, you can probably live the rest of your life in a satisfactory, fulfilling manner even with silent Chronic A-Fib.

However, having had A-Fib, I know how wonderful it is to be in normal sinus rhythm. Even though you have silent Chronic A-Fib and in general feel OK, you may want and need to get rid of your Chronic A-Fib. Most doctors understand this need to have a heart that beats normally and will work with you, as long as you understand the risks and challenges. See the options in the above question: “I Have Chronic A-Fib”.

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8.   “I have A-Fib but am allergic to Coumadin, Heparin, Lovenox and most blood thinners. I’m also very overweight. And I’ve already had one stroke.”

You might be a good candidate for a Mini-Maze operation, since you don’t have to be on blood thinners during and after a Mini-Maze operation. (See Treatments/Maze/Mini Maze for more.)

A Mini-Maze is possibly a better option if you have had a stroke or are more in danger of having a stroke during a catheter ablation.

The Mini-Maze is sometimes a better choice if you are “morbidly obese.” With current fluoroscopic imaging systems used in catheter ablation, it’s more difficult to see a clear image of the heart if someone is overweight. And greater doses of radiation often have to be used.⁵

The Radial Maze might be an option you should consider, though an allergy to blood thinners may influence whether or not the surgeon takes your case and may affect elements of the operation. If your left atrium is larger than 6.0 cm or you’ve been in A-Fib for over five years, the long term success of the “Cut and Sew” Maze operation is under 80%.⁶

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9. “I’ve had two failed left atrium ablations and have tried many different medications.” 

You can go for a third left atrium ablation, but you need to go to the best, most experienced A-Fib doctors you can find. You are a special case and deserve special treatment.

The Mini Maze operations probably wouldn’t work for you because of the reasons mentioned above (see Treatments/Maze/Mini Maze.)

A Cox Radial Maze operation may work for you. 

(An alternative to the full Cox (Radial) Maze surgery, is a variation of Mini-Maze operation called the “Five-Box Thorascopic Maze Surgery” or Total Thorascopic Maze (TTM) which was developed by Dr. John Sirak. According to Dr. Sirak’s web site, it has a “cure rate in excess of 95%.”)

A last option is Ablation of the AV Node with Pacemaker implanted. Though you are still in A-Fib and have to continue taking blood thinners and probably rate control meds, your ventricles are no longer affected by A-Fib. In general people report a better quality of life than when A-Fib made their heart race.

[무안]

좋은정보 감사합니다 마인드콘트롤이 중요하겠군요. 또한 자기만의 치료법도 연구해보아야 하겠네요

[멘델브로트]

잘 읽었습니다. 혼자 해석은 충분히 되도 국문으로 옮기기는 쉽지 않은 것인데,,대단한 배려심입니다.
또한 제 경우로 따져보면(5번 항) 현행 의료보험 가이드라인이랑 상당히 일치되는 것 같군요. 탬보코나 열심히 먹어야겠네요 ㅎㅎ
그리고 링크 동영상속 cardioversion(심율동전환술)은 인상적이네요. 전 전기생리학검사 도중 두 번 실시했었죠.

[beda]

우리나라도 자료동영상처럼 하는 지 궁금하네요. 어디선가 본자료는 넙적한 전기충격 두개를 심장에 대고 하는 거 같은데, 그충격이 엄청나다고 들은거 같고요