{"id":435,"date":"2020-01-30T12:01:55","date_gmt":"2020-01-30T11:01:55","guid":{"rendered":"https:\/\/hjerteforeningen.dk\/fagnet\/?p=5540"},"modified":"2025-12-19T13:57:38","modified_gmt":"2025-12-19T13:57:38","slug":"hjertestoed-med-maksimal-stroemstyrke-behandler-atrieflimren-mere-effektivt","status":"publish","type":"artikel","link":"https:\/\/hjerteforeningen.dk\/fagnet\/artikler\/alle-artikler\/hjertestoed-med-maksimal-stroemstyrke-behandler-atrieflimren-mere-effektivt\/","title":{"rendered":"DC-konvertering med maksimal str\u00f8mstyrke behandler atrieflimren mere effektivt"},"content":{"rendered":"\t\t
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De kliniske retningslinjer for behandling af\u00a0<\/span>atrie<\/span>flimr<\/span>en<\/span>\u00a0anbefaler, at DC-konvertering som udgangspunkt starter p\u00e5 lav styrke<\/span>,<\/span>\u00a0og at styrken \u00f8ges ved manglende effekt.\u00a0Ny dansk\u00a0forskning viser\u00a0<\/span>imidlertid,<\/span>\u00a0at maksimal st\u00f8denergi fra starten giver en mere effektiv\u00a0<\/span>og liges\u00e5 sk<\/span>\u00e5<\/span>nsom\u00a0<\/span>behandling.<\/span>\u00a0<\/span><\/h2>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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En st\u00f8dstyrke p\u00e5 360 joule<\/span>s<\/span>\u00a0i f\u00f8rste st\u00f8d har vist sig at v\u00e6re en langt mere effektiv behandling\u00a0<\/span>af atrieflimren\u00a0<\/span>end lave, stigende energier. Det er en af hovedkonklusionerne i et forskningsprojekt fra Regionshospitalet i Randers, som netop er udgivet i\u00a0<\/span>det videnskabelige tidsskrift\u00a0<\/span>European Heart Journal.<\/a><\/span><\/p>

DC-<\/span>konvertering <\/span>er daglig praksis p\u00e5 de fleste hjerteafdelinger<\/span>,<\/span>\u00a0og p\u00e5 landsplan udf\u00f8res behandling<\/span>en<\/span>\u00a0flere\u00a0<\/span>tusind<\/span>\u00a0gange\u00a0<\/span>\u00e5rligt<\/span>, b\u00e5de planlagt og akut<\/span>\u00a0<\/span>p\u00e5\u00a0<\/span>patienter med\u00a0<\/span>atrie<\/span>flimren<\/span>. S<\/span>tandardbehandlingen har i tr\u00e5d med\u00a0<\/span>b\u00e5de danske og international<\/span>\u00a0kliniske retningslinjer v\u00e6ret at\u00a0<\/span>st\u00f8de med<\/span>\u00a0lave, stigende energier<\/span>, men med den n<\/span>y forskning fra\u00a0<\/span>Regionshospitalet\u00a0<\/span>Randers<\/span>, er det muligt<\/span>,<\/span>\u00a0at behandlingsvejledninger p\u00e5 sigt skal \u00e6ndres<\/span>.<\/span><\/p>

\u00a0<\/span><\/p>

Klinisk randomiseret fors\u00f8g<\/span><\/h3>

Studiet er baseret\u00a0<\/span>p\u00e5\u00a0<\/span>et klinisk randomiseret fors\u00f8g med 276 patienter med\u00a0<\/span>atrie<\/span>flim<\/span>ren<\/span>, som i forbindelse med planlagte DC-konverteringer blev randomiseret til at f\u00e5 <\/span>enten\u00a0<\/span>standardbehandling med lave, stigende energi-st\u00f8d eller maksimale\u00a0<\/span>energi-<\/span>st\u00f8d.<\/span>\u00a0<\/span><\/p>

S<\/span>tudiet\u00a0<\/span>fandt<\/span>,\u00a0<\/span>at<\/span>\u00a0<\/span>DC-<\/span>konvertering<\/span>\u00a0med maksimal\u00a0<\/span>st\u00f8denergi p\u00e5 360<\/span>\u00a0joule<\/span>s<\/span>\u00a0<\/span>var<\/span>\u00a022 procent mere effektivt sammenlignet med standardbehandlingen<\/span>\u00a0<\/span>med lave<\/span>, stigende\u00a0<\/span>energi-<\/span>st\u00f8d\u00a0<\/span>fra<\/span>\u00a0125<\/span>\u00a0<\/span>til<\/span>\u00a0<\/span>200<\/span>\u00a0joule<\/span>s<\/span>.\u00a0<\/span>Desuden vis<\/span>te<\/span>\u00a0studiet<\/span>,<\/span>\u00a0at behandling med maksimal energi\u00a0<\/span>va<\/span>r lige s\u00e5 sikker og sk\u00e5nsom\u00a0<\/span>for patienten\u00a0<\/span>som standardbehandlingen<\/span>.<\/span>\u00a0<\/span><\/p>

For\u00a0<\/span>l<\/span>\u00e6ge og ph.d.-studerende\u00a0<\/span>Anders Sj\u00f8rslev Schmidt<\/span>\u00a0p\u00e5<\/span>\u00a0Regionshospital Randers<\/span>, som\u00a0<\/span>er\u00a0<\/span>\u00e9<\/span>n af forskerne bag studiet<\/span>,<\/span>\u00a0er resultatet v\u00e6sentligt<\/span>,<\/span>\u00a0fordi det for f\u00f8rste gang\u00a0<\/span>giver<\/span>\u00a0videnskabelig evidens\u00a0<\/span>for\u00a0<\/span>et omr\u00e5de, som forskningsm\u00e6ssigt har v\u00e6ret underbelyst.<\/span>\u00a0<\/span><\/p>

–<\/span>\u00a0<\/span>I Europa har vi ingen h\u00e5ndfaste anbefalinger\u00a0<\/span>for str\u00f8mstyrken ved behandling af<\/span>\u00a0atrieflimren<\/span>, kun at der skal st\u00f8des ved stigende energier<\/span>. Men<\/span>\u00a0vi<\/span>\u00a0<\/span>ved<\/span>,<\/span>\u00a0<\/span>at\u00a0<\/span>l\u00e6ger<\/span>\u00a0i nogle tilf\u00e6lde\u00a0<\/span>v\u00e6lger\u00a0<\/span>at starte med maksimal\u00a0<\/span>str\u00f8m<\/span>styrke<\/span>,<\/span>\u00a0fordi\u00a0<\/span>de oplever, at det<\/span>\u00a0g<\/span>i<\/span>v<\/span>er<\/span>\u00a0en mere effektiv behandling<\/span>. Nu har vi<\/span>\u00a0<\/span>evidens<\/span>,<\/span>\u00a0<\/span>som kan underbygge den erfaring,<\/span>\u00a0forklarer Ander<\/span>s<\/span>\u00a0Sj\u00f8rslev Schmidt<\/span>.<\/span><\/p>

\u00a0<\/span><\/p>

Ny moderne hjertest\u00f8dsapp<\/span>a<\/span>ratur<\/span><\/h3>

Siden de f\u00f8rste hjertest\u00f8dsapparater kom p\u00e5 markedet, er der sket en teknologisk udvikling, som har resulteret i ny<\/span>t<\/span>\u00a0og bedre apparatur<\/span>,<\/span>\u00a0<\/span>som<\/span>\u00a0er langt mere sk\u00e5nsom<\/span>t<\/span>\u00a0overfor patienten.\u00a0<\/span>\u00a0<\/span><\/p>

–<\/span>\u00a0<\/span>De moderne hjertest\u00f8dapparater er baseret p\u00e5 et<\/span>\u00a0s\u00e5kaldt<\/span>\u00a0bifas<\/span>isk\u00a0s<\/span>t\u00f8d, hvilket vil sige<\/span>,<\/span>\u00a0at str\u00f8mmen l\u00f8ber gennem hjertet to gange<\/span>. De\u00a0<\/span>er langt mere sikre\u00a0<\/span>og har lavere\u00a0<\/span>risiko for bivirkninger i form af r\u00f8dme og i\u00a0<\/span>sj\u00e6ldne<\/span>\u00a0tilf\u00e6lde forbr\u00e6ndinger<\/span>\u00a0sammenlignet med de tidlige<\/span>re<\/span>\u00a0s\u00e5kaldte\u00a0<\/span>monofas<\/span>iske\u00a0st\u00f8d<\/span>,\u00a0<\/span>for<\/span>klarer<\/span>\u00a0<\/span>Ander<\/span>s<\/span>\u00a0Sj\u00f8rslev Schmidt<\/span>.<\/span>\u00a0<\/span>\u00a0<\/span><\/p>

D<\/span>e nuv\u00e6rende\u00a0<\/span>behandlingsvejledninger for atrieflimren<\/span>\u00a0<\/span>er\u00a0<\/span>i h\u00f8j grad<\/span>\u00a0baseret p\u00e5 de<\/span>t<\/span>\u00a0tidlige\u00a0<\/span>hjertest\u00f8dsapp<\/span>a<\/span>ratur og et \u00f8nske om sk\u00e5ne patienten mest muligt\u00a0<\/span>mod<\/span>\u00a0bivirkninger.<\/span>\u00a0<\/span>Med\u00a0<\/span>ny<\/span>t<\/span>\u00a0apparatur og videnskabelig\u00a0<\/span>evidens er der<\/span>\u00a0<\/span>grund til at se om p\u00e5<\/span>,\u00a0<\/span>om vi skal<\/span>\u00a0ind og opdatere retningslinjerne<\/span>, for<\/span>t\u00e6ller<\/span>\u00a0<\/span>Anders Sj\u00f8rslev Schmidt.<\/span>\u00a0<\/span><\/p>

Gunnar Gislason, forskningschef i Hjerteforeningen<\/span>,<\/span>\u00a0er enig i den betragtning:<\/span>\u00a0<\/span><\/p>

–<\/span>\u00a0<\/span>Det er vigtigt<\/span>,<\/span>\u00a0at vi\u00a0<\/span>har\u00a0<\/span>fokus p\u00e5<\/span>,<\/span>\u00a0at nyt apparatur kan medf\u00f8re \u00e6ndringer i vores tilgang til behandling af patienter.<\/span>\u00a0Det er dette studie<\/span>, hvor man ser p\u00e5 om ny teknologi kan give\u00a0<\/span>mere effektiv<\/span>\u00a0behandling, et godt eksempel p\u00e5<\/span>. Den\u00a0<\/span>type viden og evidens skal naturligvis tages med<\/span>,<\/span>\u00a0n\u00e5r man laver\u00a0<\/span>\u00e6ndring<\/span>er<\/span>\u00a0i behandlingsvejledning<\/span>\u00a0s\u00e5dan<\/span>,\u00a0<\/span>at den kan\u00a0<\/span>komme patienterne til gode.<\/span>\u00a0<\/span><\/p>

\u00a0<\/span><\/p>

Nok med \u00e9t st\u00f8d<\/span><\/h3>

Et v\u00e6sentligt fund\u00a0<\/span>i\u00a0<\/span>studiet fra Regionshospital Randers<\/span>\u00a0<\/span>var<\/span>\u00a0at, v<\/span>ed at bruge maksimal<\/span>\u00a0<\/span>st\u00f8denergi\u00a0<\/span>kunne langt\u00a0<\/span>st\u00f8rstedelen af patienterne n\u00f8jes med\u00a0<\/span>\u00e9t<\/span>\u00a0st\u00f8d<\/span>. Desuden viste studiet,\u00a0<\/span>at risikoen for bivirkninger som r\u00f8dme, forbr\u00e6nding og smerte ikke var for\u00f8get<\/span>,<\/span>\u00a0i forhold til dem som fik standardbehandling<\/span>.\u00a0<\/span>\u00a0<\/span><\/p>

At skulle behandles med hjertest\u00f8d kan virke skr\u00e6mmende<\/span>,<\/span> og en h\u00f8j<\/span> str\u00f8mmestyrke kan lyde voldsomt. Alligevel oplever Anders Sj\u00f8rslev Schmidt ikke, at d<\/span>e h\u00f8jere str\u00f8mst\u00f8d\u00a0<\/span>bekymre<\/span>r patienterne.<\/span>\u00a0<\/span><\/p>

–<\/span>\u00a0<\/span>Jeg har talt med mange patienter<\/span>,<\/span>\u00a0om det\u00a0<\/span>at<\/span>\u00a0skulle behandles med hjertest\u00f8d<\/span>,<\/span>\u00a0og langt de fleste \u00f8nsker blot at komme af med deres rytmeforstyrrelse<\/span>,<\/span>\u00a0som giver dem mange gener<\/span>. D<\/span>erfor vil de egentlig bare gerne have den mest effektive behandling\u00a0<\/span>fra starten af<\/span>.<\/span>\u00a0<\/span>\u00a0<\/span><\/p>

\u00a0<\/span><\/p>

Yderligere forskning<\/span><\/h3>

Ud over at give evidens p\u00e5 et ellers underbelyst omr\u00e5de \u00e5bner studiet\u00a0<\/span>op for flere perspektiver og mere forskning.<\/span>\u00a0<\/span><\/p>

–<\/span>\u00a0<\/span>Vi har i<\/span>\u00a0<\/span>dette\u00a0<\/span>studi<\/span>e<\/span>\u00a0<\/span>kun<\/span> inkluderet planlagt DC-konvertering<\/span>\u00a0af\u00a0<\/span>atrie<\/span>flimren<\/span>.<\/span>\u00a0<\/span>V<\/span>i kan derfor ikke med sikkerhed sige<\/span>,<\/span> om samme fund vil g\u00f8re sig g\u00e6ldende ved akut DC-konvertering. Men det er et omr\u00e5de<\/span>,<\/span>\u00a0som b<\/span>\u00f8r\u00a0<\/span>unders\u00f8ges n\u00e6rmere<\/span>, forklarer Anders Sj\u00f8rslev Schmidt<\/span>\u00a0og forts\u00e6tter<\/span>:<\/span>\u00a0<\/span><\/p>

–<\/span>\u00a0<\/span>G\u00e5r\u00a0<\/span>vi ud over behandling af\u00a0<\/span>atrie<\/span>flimren<\/span>, s\u00e5\u00a0<\/span>er det\u00a0<\/span>relevant\u00a0<\/span>ogs\u00e5 at se p\u00e5<\/span>,<\/span>\u00a0<\/span>hvad den mest effektive str\u00f8mstyrke er i en kritis<\/span>k akut situation,\u00a0<\/span>som eksempelvis et hjertestop. Vil man kunne redde flere liv ved at st\u00f8de med maksimal styrke fra starten<\/span>?<\/span>\u00a0Det har vi ikke videnskabelig evidens for,\u00a0<\/span>men det er noget<\/span>,<\/span>\u00a0vi<\/span>\u00a0i forskningsgruppen<\/span>\u00a0\u00f8nsker at unders\u00f8ge n\u00e6rmere<\/span>.<\/span><\/p>

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\n Fakta om studiet <\/div>\n\n
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Studiet er baseret p\u00e5 et klinisk lodtr\u00e6kningsfors\u00f8g med patienter med atrieflimren ved Medicinsk Afdeling samt Operation og Intensiv p\u00e5 Regionshospitalet Randers i perioden oktober 2016 til marts 2019.<\/p>

Halvdelen af patienterne blev udtrukket til standardbehandling med lave, stigende energi-st\u00f8d i hjertest\u00f8dsbehandlingen (125-150-200J), og den anden halvdel blev behandlet med maksimalt str\u00f8mst\u00f8d (360-360-360J).<\/p>

I alt deltog 276 patienter i fors\u00f8get.<\/p>

Fors\u00f8get var enkelt-blindet s\u00e5ledes, at kun l\u00e6gen som gav hjertest\u00f8det kendte til str\u00f8mstyrken. Patienter og sygeplejersker var ikke vidende om hvilken str\u00f8mstyrke, der blev givet.<\/p> <\/div>\n <\/div>\n <\/div>\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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L<\/span>\u00e6s artiklen publiceret\u00a0<\/span>i\u00a0<\/span>European Heart Journal<\/span>\u00a0<\/span>her<\/span>:<\/span>\u00a0<\/span><\/p>

Anders S Schmidt<\/span>,<\/span>\u202f<\/span>Kasper G Lauridsen<\/span>,<\/span>\u202f<\/span>Peter Torp<\/span>,<\/span>\u202f<\/span>Leif F Bach<\/span>,<\/span>\u202f<\/span>Hans Rickers<\/span>,<\/span>\u00a0<\/span>Bo\u00a0L\u00f8fgren.\u00a0<\/span>Maximum-fixed energy shocks for cardioverting atrial fibrillation<\/span>.\u00a0<\/span>August 2019<\/span>.<\/span>\u00a0<\/span>European Heart Journal<\/span><\/a>\u202f<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

De kliniske retningslinjer for behandling af atrieflimren anbefaler, at DC-konvertering som udgangspunkt starter p\u00e5 lav styrke, og at styrken \u00f8ges ved manglende effekt. Ny dansk forskning viser imidlertid, at maksimal st\u00f8denergi fra starten giver en mere effektiv og liges\u00e5 sk\u00e5nsom behandling. <\/p>\n","protected":false},"author":21,"featured_media":631,"template":"","meta":{"_acf_changed":false},"global-tag":[16,27,28,29],"class_list":["post-435","artikel","type-artikel","status-publish","has-post-thumbnail","hentry","global-tag-atrieflimren","global-tag-behandling","global-tag-forskning","global-tag-studie"],"yoast_head":"\nDC-konvertering med maksimal str\u00f8mstyrke behandler atrieflimren mere effektivt - For fagfolk<\/title>\n<meta name=\"description\" content=\"De kliniske retningslinjer for behandling af atrieflimren anbefaler, at DC-konvertering som udgangspunkt starter p\u00e5 lav styrke\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/hjerteforeningen.dk\/fagnet\/artikler\/alle-artikler\/hjertestoed-med-maksimal-stroemstyrke-behandler-atrieflimren-mere-effektivt\/\" \/>\n<meta property=\"og:locale\" content=\"da_DK\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"DC-konvertering med maksimal str\u00f8mstyrke behandler atrieflimren mere effektivt - 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