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1、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 6
2、0 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
3、 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 L
4、AA 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 I 1. Before initiating antiarrhythmic drug therapy, treatment of precipitating or reversible causes of AF is recommended. (Level of Evidence: C) 2. The
5、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
6、) 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
7、 other agents have failed or are contraindicated. (130, 138, 143-146). (Level of Evidence: C),维持窦律：导管消融,Class I 1. 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 (3
8、63, 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 IIa 1. AF catheter ablation is reasonable for selected patients with sympto
9、matic 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 antiarr
10、hythmic 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 IIb 1. 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 antiarrhyt
11、hmic 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
12、desired. (Level of Evidence: C),导管消融治疗房颤,Class III: Harm 1. 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！,