2014-ACC房颤指南解读.ppt

2014 AHA/ACC/HRS 心房颤动患者管理指南解读,2,2014年3月28日在线发表,美国AHA/ACC/HRS共同推出了新的房颤指南，以替代2006年版房颤指南和2项于2011年更新的指南。新指南参考了大量近几年来关于房颤诊疗的研究资料，并参考了2012年ESC房颤指南，新的指南与之前的相比做出了大量的修改。,房颤的重要性,AF is a common cardiac rhythm disturbance and increases in prevalence with advancing age.Approximately 1%of patients with AF are 60 years of age,whereas up to 12%of patients are 75 to 84 years of age.Morethan one third of patients with AF are 80 years of age AF is associated with a 5-fold increased risk of stroke and stroke risk increases with age.AF-related stroke is likely to be more severe than nonAF-related stroke.AF is also associated with a 3-fold risk of HF,and 2-fold increased risk of both dementia and mortality,房颤分类：简化,房颤的机制以及病理生理学,血栓栓塞预防的抗凝治疗建议,血栓栓塞预防的抗凝治疗建议,血栓栓塞预防的抗凝治疗建议,非瓣膜疾病房颤患者抗凝及出血的风险分层,推荐使用CHA2DS2-VASc评分进行房颤卒中风险评估，同时使用HAS-BLED评估接受抗凝治疗患者的出血风险,心脏外科手术左心耳（LAA）封堵/切除术,Class IIb Surgical excision of the LAA may be considered in patients undergoing cardiac surgery.(Level of Evidence:C),14,房颤患者的室率和节律控制,房颤室率控制,房颤和房扑复律治疗建议,房颤和房扑复律治疗建议,维持窦律抗心律失常药,Class I1.Before initiating antiarrhythmic drug therapy,treatment of precipitating or reversible causes of AF is recommended.(Level of Evidence:C)2.The following antiarrhythmic drugs are recommended in patients with AF to maintain sinus rhythm,depending on underlying heart disease and comorbidities(Level of Evidence:A):a.Amiodarone(130-133)b.Dofetilide(125,129)c.Dronedarone(134-136)d.Flecainide(131,137)e.Propafenone(131,138-141)f.Sotalol(131,139,142),维持窦律：抗心律失常药物,3.The risks of the antiarrhythmic drug,including proarrhythmia,should be considered before initiating therapy with each drug.(Level of Evidence:C)4.Owing to its potential toxicities,amiodarone should only be used after consideration of risks and when other agents have failed or are contraindicated.(130,138,143-146).(Level of Evidence:C),维持窦律：导管消融,Class I1.AF catheter ablation is useful for symptomatic paroxysmal AF refractory or intolerant to at least 1 class I or III antiarrhythmic medication when a rhythm control strategy is desired(363,392-397).(Level of Evidence:A)2.Prior to consideration of AF catheter ablation,assessment of the procedural risks and outcomes relevant to the individual patient is recommended.(Level of Evidence:C),导管消融治疗房颤,Class IIa1.AF catheter ablation is reasonable for selected patients with symptomatic persistent AF refractory or intolerant to at least 1 class I or III antiarrhythmic medication(394,398-400).(Level of Evidence:A)2.In patients with recurrent symptomatic paroxysmal AF,catheter ablation is a reasonable initial rhythm control strategy prior to therapeutic trials of antiarrhythmic drug therapy,after weighing risks and outcomes of drug and ablation therapy(401-403).(Level of Evidence:B),导管消融治疗房颤,Class IIb1.AF catheter ablation may be considered for symptomatic long-standing(12 months)persistent AF refractory or intolerant to at least 1 class I or III antiarrhythmic medication,when a rhythm control strategy is desired(363,404).(Level of Evidence:B)2.AF catheter ablation may be considered prior to initiation of antiarrhythmic drug therapy with a class I or III antiarrhythmic medication for symptomatic persistent AF,when a rhythm control strategy is desired.(Level of Evidence:C),导管消融治疗房颤,Class III:Harm1.AF catheter ablation should not be performed in patients who cannot be treated with anticoagulant therapy during and following the procedure.(Level of Evidence:C)2.AF catheter ablation to restore sinus rhythm should not be performed with the sole intent of obviating the need for anticoagulation.(Level of Evidence:C),小结,房扑被特别强调CHA2DS2-VASc取代CHADS2阿司匹林地位下降新型抗凝药成为治疗新选择导管消融的作用更加突出,谢谢！,