Prospective analysis of the patients with atrial fibrillation with high ventricular response

Purpose: In our study, we aimed to obtain some data about demographical characteristics, the reasons for high velocity, antiarrhythmic agents that are used in treatment, some parameters that can be effective in short-term mortality, the management of emergency service, the facilitation of discharging or hospitalizing decisions in the patients with atrial fibrillation with high ventricular response. Material and Method: Our prospective study was conducted in the Çukurova University Faculty of Medicine Emergency Service between the dates of November 20, 2016 and April 24, 2018 after getting the approval of Çukurova University Ethics Committee. The patients who were above 18 years old and who have atrial fibrillation with high ventricular response were included into our study. The type of AF and the secondary reasons that can increase the velocity of AF were investigated. Within the scope of this study, the diameter of Vena Cava Inferior (VCI) was measured by means of bedside ultrasound in order to evaluate the volume condition of the patient. Lactate levels and base deficit levels of all patients were taken. Short term mortalities of 15 to 30 days of the patients were questioned. The parameters related with mortality of the cases which show mortal in 15 and 30 days were analysed. Findings: 57 male and 46 female patients, 103 in total, were included in our study. The average age of the patients who participated in the study was found as 66.7±15.1 years. The secondary reasons that underlie high ventricular response were investigated, clinical pictures together with AF were determined. When the clinical pictures that accompany AF were considered, it was seen that coronary failure was in the first rank with 15.5% and hypovolemia was in the second rank with 13.6%. Hypoxia (6.8%), fever (4.9%), anemia (2.9%) and ache (1.9%) follow respectively. It was monitored that high ventricular velocity of 14.6% of all patients got better by managing the clinical picture underlying without giving any antiarrhythmic drug. Lactate and base deficit levels in the blood gas were found significantly higher in the patients who course mortal in 15 and 30 days than in the patients who are alive. The diameter of inferior vena cava guided the clinician about the intravascular volume and prevented the antiarrhythmic treatment in dehydrated patients. Result: The secondary reasons must be examined in the patients with AF with high ventricular response before giving any treatment to reduce morbidity rate. In addition to anamnesis and physical examination, USG and the measurement of IVC can give information about the volume condition of the patients and prevent unnecessary antiarrhythmic treatment. While emergency physicians are giving decisions of discharging or hospitalizing the patients with AF with high ventricular response, base deficit and lactate levels which were found significantly high in short term mortality can be a guide for the clinician. Keywords: Atrial fibrillation, Inferior vena cava, Lactate, Base deficit.