Fibrilación auricular (página 2)

OBJETIVO DEL
ESTUDIO

Se diseña un estudio para 170 pacientes que
acuden al Servicio de
Urgencias de Cardiología del Hospital San Jacob .Hardbord.
Connecticut, a los que se les administró aleatoriamente
uno de los 5 tratamientos durante 1 año.
La fase experimental del estudio comprendía 6 meses de
tratamiento monitorizado y 1 año de tratamiento no
monitorizado.

Al cabo de 6 meses se calculó el promedio mensual
de cifras de Frecuencia cardiaca y al cabo de 1 año se
evaluó en una escala subjetiva
de 5 niveles el grado de eficacia del
tratamiento en relación a las pautas de adherencia y de
mantenimiento
de Frecuencia Cardiaca en límites
controlados (en rango de 60-110 cx´).

Se utilizó como técnica estadística la Prueba de la varianza de un
factor, como extensión natural de la prueba de t-Student.
La variable "Respuesta" es cuantitativa y, en este caso, la
variable "Explicativa" es cualitativa de más de dos
categorías. Básicamente se desea probar si hay
diferencias estadísticamente significativas entre las
medias de los grupos formados
por la variable explicativa.

Las dispersiones de grupo fueron
homogéneas y la variable "respuesta" fue normal en los
grupos formados. Si no se cumpliera alguna de estas dos
condiciones se comparan las Mediana de los grupos formados
mediante la prueba no paramétrica de
Kruskal-Wallis.

RESULTADOS

Se distribuyo aleatoriamente a los pacientes que
cumplían criterios (Clínicos y
Electrocardiográficos) de Fibrilación Atrial en 5
grupos homogéneos de 34 pacientes/grupo. Un grupo fue
tratado con 0,250 mgrs diarios de Digoxina. El segundo grupo con
Digoxina asociada a Amiodarona. El tercer grupo con Digoxina
asociada a Flecaínida. El cuarto grupo con Digoxina
asociada a Propafenona y el quinto grupo con Digoxina asociada a
Diltiacen.

Se calcularon las tasas de eventos
acumuladas según el método de
Kapplanl-Meier.

Validación de Variables

Grupos A B C D
E (Tratamientos)

Para el recuento de pacientes por tratamiento y la
distribución de la Variable "Evolución":Frecuencias

Número de Casos: 170

EVALUACIÓN Frecuencias
Porcentajes

Estadísticos descriptivos adecuados para la
variable DFC en función de
los diferentes Tratamientos:

Estadísticos para la variable DFC por
TTO

Los tratamientos A,B,C, presentan una eficacia similar
alrededor de 38 cx´ de disminución de Frecuencia
Cardiaca.

El Tratamiento D es el más eficaz con una
disminución de Frecuencia Cardiaca promedio de 51
cx´.

El Tratamiento E es el menos eficaz con una
disminución de FC. De 32 cx´.

Disminución de FC en cx´
1

Para saber si existen diferencias significativas entre
el número medio de descenso en Frecuencia Cardiaca en cada
tratamiento, utilizamos el Estadístico "Anova un
Factor":

Dado que el valor p= 0.0007E se rechaza la
HIPÓTESIS
NULA.

Se concluye que las medias de DFC de los diferentes
grupos de tratamiento NO SON IGUALES. Existiendo Diferencias
Estadísticamente significativas entre los distintos
tratamientos.

Para saber si es válido el modelo Anova
estudiamos la homogeneidad de las varianzas de los diferentes
grupos de Tratamiento y la normalidad de Residuos y Predicciones
del modelo anterior. Para ello calculamos el Estadístico B
de la "Prueba de Bartlett" como prueba de
Elección..

Bartlett nos da un estadístico de B= 0.8128 que
resulta NO significativo para un valor de p= 0.9367, concluyendo
entonces que no hay diferencias entre las dispersiones de la
respuesta a los diferentes tipos de Tratamientos y que los grupos
son homocedásticos para esta variable.

Al existir homogeneidad de varianzas, no
observándose patrones de comportamiento
y existiendo simetría en los Residuos, se concluye que el
"modelo Anova" está correctamente aplicado y es
Válido.

De no resultar valido, utilizaríamos la "Prueba
de Tukey" para contrastes múltiples entre los diferentes
tratamientos.

Así se establece:

– Entre los tratamientos E, A, B y C no existen
diferencias estadísticamente significativas.

– El Tratamiento D es, estadísticamente diferente
y MÁS EFICAZ que todos los demás.

-El valor que aparece en +/- Limite de 0.9294 es la
diferencia que deben tener dos tratamientos para ser
estadísticamente diferentes.

– La significación de diferencia se establece a
un nivel inferior a 0.05.

ANÁLISIS DE LOS TRATAMIENTOS EN RELACIÓN A
LA VARIABLE "EVALUACIÓN

Los Tratamientos A, B y C presentan una Eficacia similar
entre 1.88-2.17 puntos.

El Tratamiento D es el más eficaz con un promedio
d 2.58 puntos.

El Tratamiento E es el menos eficaz con promedio de 1.58
puntos.

Dado que el valor p= 0.0184 se rechaza de nuevo
HIPÓTESIS NULA. Así se concluye que " La
Evaluación no es igual para los diferentes
Tratamientos"

Utilizamos también la "Prueba de Kruskal-Wallis"
para comparación de poblaciones con distribuciones no
normales ni iguales entre si:

Diferencia Estadísticamente significativa para p=
0.0161 con Medianas de los Tratamientos no iguales.

La diferencia de Tratamiento D con rango medio de 106.2
frente a Tratamiento E con rango medio de 67.55 (106.2- 67.55 =
38.65) supera el valor crítico de 32.70, por lo que se han
encontrado diferencias en relación a la variable
Evaluación a un nivel de significación de 0.05. No
se encuentran diferencias significativas entre Tratamientos A, B
y C frente a E ni frente a D.

CONCLUSIONES.

Al desear saber si existen diferencias de eficacia entre
5 Tratamientos para la disminución de Frecuencia Cardiaca
(DFC), la misma se establecerá por el promedio mensual
durante 12 meses en rango de medición de: Inicio-6 meses-1 año,
de disminución de dicha Frecuencia Cardiaca, así
como por la valoración subjetiva y adhesión al
Tratamiento propuesto por parte de los pacientes (170 pacientes).
En el caso que los tratamientos dieran resultados diferentes se
estableció qué tratamientos eran diferentes entre
si.

El estudio se diseño
sobre 170 pacientes afectos de Fibrilación Atrial No
controlada (mayor de 100 cx´) y que cumplieran los
Criterios de Inclusión. Se les administró,
aleatoriamente, uno de los 5 tratamientos
considerados.

A los 6 mese se calculó el promedio mensual de
Disminución de Frecuencia Cardiaca ó la
estabilización de la misma dentro de rango inferior a 100
cx´. Al año se evaluó, en escala subjetiva de
0-4 (5 niveles) el grado de eficacia del Tratamiento seguido en
relación a las pautas de adherencia y de mantenimiento de
Frecuencia Cardiaca en limites aceptables (Fibrilación
Atrial Controlada).

A modo de Conclusiones finales, tras el Ensayo se
puede afirmar:

No existen diferencias significativas entre los
Tratamientos A, B y C presentando ellos una eficacia similar
alrededor de 38 cx´ de disminución
global.

El Tratamiento D, resultó ser el más
eficaz con una disminución Promedio de 51
cx´.

El Tratamiento E resultó el menos Eficaz con una
disminución de Frecuencia Cardíaca de 32 cx
promedio.

Se rechaza Hipótesis Nula a un valor p=
0.0001.

Se concluye que existen diferencias
estadísticamente significativas entre
tratamientos.

DISCUSIÓN.

Todas las formas de tratamiento empleadas fueron
eficaces en mayor o menor medida, reduciendo cifras de frecuencia
cardiaca en ciclos por minuto.

La Terapia más efectiva fue la combinación
de Digoxina con Diltiacen (Antagonista del calcio de la familia de
las Benzodiacepinas).

La terapia menos efectiva fue la Digoxina
aislada.

En el resto de Terapias no hubo diferencia
significativa.

Proponemos, entonces, como Terapia de Elección en
el control de una
Fibrilación Atrial,- tanto paroxística, permanente
ó persistente-, la combinación Digoxina-Diltiacen
en pautas expuestas.

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ATRIAL FIBRILLATION

COMPARATIVE STUDY WITH FIVE GUIDELINES OF
TREATMENT.

(CLINICAL TEST ON 170
PATIENT AFFECTION DE ACxFA)

Author:

Prof. Dr Francisco Ramon Breijo
Márquez.

(Invitad professor)

Department of Clinical and Experimental
Cardiology.

Sant Jacob's Hospital. Hardford. Connecticut

.

HYPOTHESIS

To compare the effects of fixed dose of Digoxina
separately and in comparison with four antiarrhythmic drugs in
doses fit for the control of Frequency Cardiac in patients with
Atrial Fibrillation as well as to avoid the greater number of new
episodes. The Null hypothesis would be that significant
differences with these drugs in relation to isolated Digoxina do
not exist.

SUMMARY

Well-known from the times of Hipócrates, the
Atrial Fibrillation is, possibly, the more frequent Arrhythmia
Cardiac after the Sinusal Tachycardyc. They have seted out
different, – throughout the Times -, treatments as much for
Control of the Frequency like of the Rate. Within these
Treatments (Cardioversión Pharmacological) perhaps they
are the Digitalics those that marked a time at the beginning of
S.XIX.

Key words: Atrial Fibrilation.
Cardioversión Farmacológica. Breijo. Anova.
Kruskal-Wallis. Turkey.

BRIEF INTRODUCTION

Mechanism: These abnormal rates are originated in
the auricle from ectópics centers. They are characterized
being "irregularly irregular". (Chaotic Depolarisations atrials
rights) The impulses are unloaded to frequencies that can be low
or of up to 400 or more beats per minute. These frequencies do
that the auricle depolarised very disorganizedly without
appropriate contractions exist. This disorganization generates
irregularities in the pattern of waves of the EKG. The waved
deflections present/display varied forms and patterns. The base
line of the layout adopts the form of small undulations from very
fine to crude. Distinguishing characteristics: Frequency:
Anyone, from slow to very fast the smaller frequencies of 100
greater frequencies of 100 are denominated "controlled".
(Controlled Frequency) The denominate "uncontrolled"
(Uncontrolled Frequency). Controlled frequencies are easy to
identify, whereas the uncontrolled frequencies are more
complicated. The auricular frequencies of 400 or cannot more be
moderate. Waves: The P Waves are absent (due to the auricular
activity chaotic). Interval PR: Given the absence of P waves,
interval PR does not exist. Wide of the QRS: Normal limits of
0.10 seconds or less (although at intervals irregular).
Leading factors: These patterns can appear in normal
individuals and are usually transitory. Stress or
alcohol in
excess can cause them. If they do not revert spontaneously, the
pharmacological agents are effective in these cases to return to
a normal sinuses rate. The chronic auricular fibrillation
(Persistent or Permanent) is related to a set of problems that
include valvulopathy, coronary or hypertensive cardiopathy,
miocardiopathy, Inflammation of the myocardium. Inflammation of
the pericardium. Hypotiroidism, Cardiac insufficiency, pulmonary
disease and can appear after a cardiac surgery. He is one of more
common the abnormal heart rates. The temblors cardiac cameras not
contracted appropriately and they fill of blood in the last part
of diastole. The volume minute is reduced until in a 25%. The
stagnation of blood in the camera increases the potential of
formation of clots and consequently there are more possibilities
of systemic tromboembolismo and ACV. The treatment must indicate
carefully since the restoration of the normal function of the
heart can cause the loosening of a clot and cause systemises
embolisms.

Frequency: In the US: Prevalence is approximately
3% of the US adult population; incidence is 1 case per 1000
adults per year.

Mortality/Morbidity:

Much of the morbidity and some of the mortality
resulting from AF are due to stroke. The risk of stroke is not
due solely to AF; it increases substantially in the presence of
other cardiovascular disease. The attributable risk of stroke
from AF is estimated to be 1.5% for those aged 50-59 years, and
it approaches 30% for those aged 80-89 years.

AF complicates acute myocardial infarction (AMI) in
5-10% of cases. The causes of AF in AMI are thought to be due
to any number of factors, such as atrial infarction, atrial
ischemic injury, atrial distension, or, perhaps, pericarditis.
According to Rathore, et al, patients who developed new-onset
AF during the course of myocardial infarction (MI) were at
higher risk than patients who presented with chronic AF.
Patients with AMI and AF tend to be older, be less healthy, and
have poorer outcomes during hospitalization and after discharge
than individuals without AF. AF is independently associated
with an increased mortality rate.

Sex: Incidence is higher in men than in
women.

Age:

• The incidence in persons aged 60-68 years is
  1%.

• The incidence in persons older than 69 years is
  5%.

MATERIAL and METHODS.

Design AND TARGET OF STUDY

DESIGN of the STUDY

With random allocation.

Monocéntric (Hospital of Sant
Jacob.CON.)

Cases – controls.

Blind double.

Pilot to 12 months.

Patients Evaluated for possible inclusion:
765,

Patients including 170.

Pursuit 6 and 12 months.

Analysed Variables:

– Rules of 5 Treatments for control of Frequency in ACx
FA not controlled FA.

– Decrease of Cardiac Frequency. (DFC).

– Subjective evaluation of the patient at the age of 6
and 12 months of beginning of Treatment.

– Number of new episodes in 6 months and 1
year.

– Efficacy of different Treatments.

DRUGS and USED TECHNIQUES

-Amiodarona + Digoxina. (Treatment A)

– Flecainída + Digoxina. (Treatment B)

– Propafenona + Digoxina. (Treatment C).

– Diltiacen + Digoxina. (Treatment D).

– Digoxina (Patient Control) 0.250 mgr/day during 12
months. (Treatment E).

CRITERIA OF INCLUSION

Age 75-year-old minor.

Revenue previous in Hospitable Unit for
Control.

Characteristics Typical Electrocardiographic
of

Atrial Fibrillation with Study Holter of 24 hours after
the control of Frequency.

To be in Rank of 2-3 INR (Coagulation’s
Preview).

CRITERIA OF EXCLUSION

Death in the Hospital.

Need of Cardiology Interventionist.

Complications added Electrocardiographic.

Pathology associated with danger of the life.

Absence in adhesion to the treatment or patients' bad
availability.

Hypersensitivities known to some of the
medicines.

TREATMENT GUIDELINES

* Hospitable Treatment:

– 250 cc of SSF with 0, 50 mgrs of Digoxin in Perfusion
to 19 millilitre h. (Control).

– 250 cc SG with Guideline previous + 300 mgrs of
Amiodarona to 19 ml/h.

– 250 cc SG with Digoxin + 150 mgrs of Flecainid to 19
ml/h.

– 250 cc of SG with Digoxina + 1 mgr kg of Propafenona
to 19 ml/h.

– 250 cc SG with Digoxina + 15 mgrs/ hour of Diltiacen
in perfusion

* Extra hospitable Treatment:

– Digoxin 0, 25 mgrs/day V.O.

– Digoxin 0, 25 mgrs + 300 mgrs of Amiodarone. V.O. /
day.

– Digoxin 0, 25 mgrs + 100 mgrs of Flecainid V.O. /
day.

– Digoxin 0, 25 mgrs + 300 mgrs of Propafenona
V.O./day.

– Digoxin 0, 25 mgrs + 300 mgrs of Diltiacen V.O. /
day.

OBJECTIVE OF THE STUDY

Is desired to establish if there are differences of
effectiveness between five treatments for the control of the
Frequency in the Paroxístyc Auricular Fibrillation. The
effectiveness will settle down by the monthly average of
Frequency Cardiac and new events of tachycardyc. As well as by
the subjective valuation of effectiveness in the long, term. In
case one demonstrates that the treatments are not equal, it is
desired to establish what treatments are different between
if.

The effectiveness of five treatments for the control of
the Frequency in randomised cases of Atrial Fibrillation
Paroxístic is compared. A study for 170 patients is
designed who go to the Service of Urgencies of Cardiology of the
San Jacob’s Hospital, Massachusetts. To that, one of the 5
treatments was administered to them randomly. The experimental
phase of the study included/understood 6 months whit monitor
treatment and 1 year of treatment no monitor. After 6 months the
monthly average of numbers of Frequency calculated cardiac and
after 1 year the degree of effectiveness of the treatment in
relation to the adhesion guidelines was evaluated in a subjective
scale of 5 levels and of maintenance of Frequency Cardiac in you
limit controlled (in 60-110 rank cx´)

The Test of the variance of a factor was used like
statistical technique, like natural extension of the test of
t-Student. The variable "Answer" is quantitative and, in this
case, "the Explanatory" variable is qualitative of more than two
categories. It is desired to prove if there are statistically
significant differences between the averages of the groups formed
by the explanatory variable.

The group dispersions were homogenous and the variable
"answer" was normal in the formed groups. If some of these two
conditions were not fulfilled, they compare the Medium one of the
groups formed by means of the nonparametric test of
Kruskal-Wallis.

RESULTS

I distribute myself to the patients randomly who
fulfilled criteria (Clinical and Electrocardiographic) of
Fibrillation Atrial in 5 group’s whit 34 homogenous of
patients. A group was dealt with 0.250 mgrs daily of Digoxina.
The second group with associated Digoxina to Amiodarona. The
third group with associated Digoxina to Flecaínida. The
fourth group with associated Digoxina to Propafenona and the
fifth group with associated Digoxina to Diltiacen. The rates of
accumulated events calculated according to the method of
Kapplanl-Meier.

Validation of Variables

Number of Cases: 170 Numerical Variable Valid Maximum
Minimum Cod. Pac 170 170 1,0 170,0 TTO 170 0 — — 7,3 DFC 170
170 1,25 EVALUATION 170 170 0,0 4.0. Groups To B C D E
(Treatments) N 34 34 34 34 34 Medium Average 3,7782 3,84 3,972
5,100 3,2500 4,2450 3,7150 3,82 5,4350 3.4100 For the count of
patients by treatment and the distribution of the Variable
"Evolution": Frequencies Number of Cases: 170 TTO Frequencies
Percentage To 34 20,00 B 34 20,00 20,00 Cs 34 D 34 20,00 And 34
20.00 Total 170 100.00 EVALUATION Frequencies Percentage 4 26
15,29 3 40 23,53 1 38 22,35 0 22 12,94 2 44 25.88 Total 170
100.00. Statistical descriptive adapted for variable DFC based on
the different Treatments: Statistical for variable DFC by TTO –
Groups To B C D E N 34 34 34 34 34 Medium Average the 3,7782
3,8465 3,9721 5,1003 3,2500 4,2450 3,7150 3,8250 5,4350 3,4100
treatments To, b, c, presents/displays a similar effectiveness
around 38 cx´ of diminution of Frequency Cardiac. Treatment
D is the most effective with a diminution of Frequency Cardiac
average of 51 cx´. The Treatment and is less effective with
a diminution of FC. Of 32 cx´.

In order to know if significant differences between the
average numbers of reduction in Frequency Cardiac in each
treatment exist, we used the Statistical "Anova a
Factor":

Anova A Factor

Variable Answer: Explanatory Variable DFC: TTO Number of
Cases: 170 Extreme of Square Square G.L. Half F-value p-value
Between 7,9507 Groups 62,7680 4 15,6920 0.0007E-2 Inside Groups
325,6535 165 1.9737 Total (corr.) 388.4215 169.

Since the value p = 0.0007E rejects the NULL HYPOTHESIS.
One concludes that the averages of DFC of the different groups
from treatment ARE NOT EQUAL.

Existing Statistically significant Differences between
the different treatments. In order to know if it is valid the
Anova model we studied the homogeneity of the variances of the
different groups from Treatment and the normality of Remainders
and Predictions of the previous model. For it we calculated
statistical B of the "Test of Bartlett" like test of Election.
Anova A Factor, Homocedasticidad Variable Answer: Explanatory
Variable DFC: TTO Number of Cases: 170 Test C of Cochran: 0,2297
P-value = 1,0000 Test of Bartlett: 0,8128 P-value = 0,9367
Bartlett gives statistical of B = us 0,8128 that is no
significant for a value from p = 0,9367, concluding then ones
that are no differences between the dispersions of the answer to
the different types from Treatments and that the groups are
homocedásticos for this variable. When existing
homogeneity of variances, not being observed behaviours patterns
and existing symmetry in the Remainders, concludes that the
"Anova model" correctly is applied and is Valid. Of not being
court favourite, we would use the "Test of Tukey" for multiple
resistances between the different treatments. Anova A Multiple
Factor, Comparisons Variable Answer: Explanatory Variable DFC:
TTO Number of Cases: 170 Method: Tukey HSD to the 95.00%
Homogenous Groups Average TTO N And 34 3,2500 Xs To 34 3,7782 Xs
B 34 3,8465 Xs C 34 3,9721 Xs D 34 5,1003 Xs Limit Resists
Difference +/- To versus B -0,0682 0,9294 To versus C -0,1938
0,9294 To versus D * – 1,3221 * 0,9294 To versus and 0,5282
0,9294 B -0,1256 versus C 0,9294 B versus D * – 1,2538 * 0,9294 B
versus and 0,5965 0,9294 Cs versus D * – 1,1282 * 0,9294 Cs
versus and 0,7221 0,9294 D versus and * 1,8503 *
0.9294

*/statistically significant
Difference.

Thus one settles down: – Between the treatments and, To,
B and C statistically significant differences do not exist. –
Treatment D is, statistically different and MORE EFFECTIVE than
all the others. – The value that appears in +/- It limits of 0,
9294 is the difference that must have two treatments to be
statistically different. – The difference meaning settles down at
an inferior level to 0.05. Thus one settles down: – Between the
treatments and, To, B and C statistically significant differences
do not exist. – Treatment D is, statistically different and MORE
EFFECTIVE than all the others. – The value that appears in +/- It
limits of 0,9294 is the difference that must have two treatments
to be statistically different. – The difference meaning settles
down at an inferior level to 0.05.

ANALYSIS OF The TREATMENTS In relation to The
VARIABLE "EVALUATION Statistical for the variable EVALUATION
by TTO Groups To B C D E N 34 34 34 34 34 Medium Average the
2,0588 1,8824 2,1765 2,5882 1,5882 2,0000 2,0000 2,0000 3,0000
1,0000 Treatments To, B and C presents/displays a similar
Effectiveness between 1.88-2.17 points. Treatment D is the most
effective with an average d 2,58 points. The Treatment and is
less effective with average of 1,58 points. Anova A Variable
Factor Answer:

Explanatory Variable EVALUATION:

TTO Number of Cases: 170 Extreme of Square G.L. Half
F-value p-value Between Groups 18,5882 4 4,6471 3,0570 0,0184
Inside Groups 250,8235 165 1.5201 Total (corr.) 269.4118 169
Since the value p = 0,0184 rejects NULL HYPOTHESIS again. Thus
one concludes that "the Evaluation is not equal for the different
Treatments" We also used the "Test of Kruskal-Wallis" for
comparison of populations with no normal nor equal distributions
between if:

Kruskal-Wallis Variable

Answer: Explanatory Variable EVALUATION: TTO Number of
Cases: 170 Extreme groups n of Rm Ranks Average Rank To 34
2921,0000 85,9118 B 34 2651,0000 77,9706 89,8529 Cs 34 3055,0000
D 34 3611,0000 106,2059 And 34 2297,0000 67.5588 Statistical of
Kruskal-Wallis (without correction by ties): 11.5990 Statistical
of Kruskal-Wallis (with correction by ties): 12,1742 Degrees of
freedom: 4 p-value: 0.0161.

Statistically significant difference for p = 0,0161 with
Medium of the no equal Treatments. The difference of Treatment D
with average rank of 106,2 as opposed to Treatment and with
average rank of 67,55 (106,2- 67,55 = 38,65) surpasses the
critical value of 32,70, reason why have been differences in
relation to the variable Evaluation at a level of 0.05 meaning.
Are not significant differences between Treatments To, B and C as
opposed to and nor as opposed to D.

CONCLUSIONS.

When wishing to know if differences of effectiveness
between 5 Treatments for the diminution of Frequency Cardiac
exist (DFC), the same one will settle down by the monthly average
during 12 months in rank of measurement of: Beginning

6 months-1 year, of diminution of this Frequency
Cardiac, as well as by the subjective valuation and adhesion to
the Treatment proposed on the part of the patients (170
patients). In the case that the treatments gave different results
settled down what treatments were different between if. The study
design on 170 patient affection of Atrial Fibrillation no
controlled (greater of 100 cx´) and that fulfilled the
Criteria of Inclusion. It was administered to them, randomly, one
of the 5 considered treatments. To the 6 cx´ pulls
calculated the monthly average of Diminution of Frequency Cardiac
or the stabilization of the same one within inferior rank to 100.
To the year it was evaluated, in subjective scale of the 0-4 (5
levels) degree of effectiveness of the Treatment followed in
relation to the adhesion guidelines and of maintenance of
Frequency Cardiac in you limit acceptable (Atrial Fibrillation
Controlled). As final Conclusions, after the Test it is possible
to be affirmed: Significant differences between Treatments A, B
and C does not exist presenting/displaying them a similar
effectiveness around 38 cx´ of global diminution. Treatment
D turned out to be the most effective with a diminution Average
of 51 cx´. The Treatment and was less Effective with a
diminution of 32 Cardiac Frequency of cx average. Null Hypothesis
to a value is ejected p = 0.0001. One concludes that
statistically significant differences between treatments
exist.

DISCUSSION.

All the used forms of treatment were effective in
greater or smaller measurement, reducing numbers of frequency
cardiac in cycles per minute. The most effective Therapy was the
combination of Digoxin with Diltiacen (Antagonistic of calcium of
the family of the Benzodiacepins). The less effective therapy was
the isolated Digoxin. In the rest of Therapies there was no
significant difference. We propose, then, like Therapy of
Election in the control of a Atrial Fibrillation, –
paroxístyc, permanent or persistent -, the
Digoxin-Diltiacen combination in exposed guidelines.

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Autor:

Prof. Dr. Francisco Ramón
Breijo Márquez.

(Profesor
Invitado)

Departamento de Cardiología Clínica y
Experimental.

Sant Jacob’s Hospital. Hardford.
Connecticut

Correspondencia: .