心房颤动指南解读(华化令).ppt 2.pptVIP

Atrial Fibrillation Update 2012 2% VF Hypertension Aging Male sex Obesity/metabolic syndrome/diabetes Ischemic heart disease Heart failure/diastolic dysfunction Obstructive sleep apnea Physical inactivity Thyroid disease Inflammation? Relieve symptoms Prevent Stroke Prevent Heart Failure 2010年心律失常治疗理念发生了转变，提出了“三降三升”的新理念，以降低死亡率、住院率和脑卒中率，提升患者的生活质量、心功能和活动耐量为房颤治疗目标 如房颤可能危及生命，在不考虑抗凝情况下立即除颤 房颤持续的时间不明或≥48h, 需抗凝治疗 准备：1)传统选择?华法林3周，INR2-3时转复；2) TEE/Heparin ?无心房血栓即可转复(INR ≥2) 复律后继续抗凝治疗4周(复律后几周内仍有脑卒中的高风险) 目前的随机对照研究 RACE (Rate control vs.Electrical cardioversion for persistent atrial fibrillation) PIAF (The Pharmacological Intervention in Atrial Fibrillation) STAF(The Strategies of Treatment of Atrial Fibrillation) AFFIRM (The Atrial Fibrillation Follow-up Investigation of Rhythm Management) Narrow therapeutic window Wide variation in metabolism, with numerous food and drug interactions Need for regular coagulation monitoring and dose adjustment Slow onset/offset 狭窄的抗凝治疗指数范围和抗凝不当所致的并发症就一直困扰着每一位临床医生。直到近年来突破性地明确了CYP2C9基因多态性与华法林敏感有关之后，一切才为之而改变。 CYP2C9*3纯合子病人每天只需0.5mg消旋华法林，而CYP2C9野生型病人每天需5-8mg(相差十多倍)才能达到相同的治疗效果。CYP2C9*3病人治疗之初还表现更多的不良反应以及出血并发症的危险性。 黄盛文 学科专业 细胞生物学 授予学位 博士 授予单位 南方医科大学 导师姓名 徐湘民 学位年度 2008 Surgical and Minimally Invasive Surgical Ablation Reprinted with permission from Sundt TM 3rd, et al. Cardiol Clin. 1997;15(4):739-748. Cox-Maze Procedure In a trial of 190 patients, 1987-1997: 92% had freedom from AF and were off AAD agents Left Atrial Appendage (LAA) Closure vs Warfarin for Prevention of Stroke in Patients with AF Holmes D, et al. Lancet. 2009;374:534-542. Control: warfarin INR 2.0-3.0 Intervention: percutaneous closure of LAA Efficacy Composite endpoint of stroke, cardiovascular death, and systemic embolism Safety Composite endpoint of events related to excessive bleeding or procedure-related complications Intervention: 3.0 events per 100 patient yrs Warfarin Control: 4.9 events per 100 patient yrs Rate ratio (95% CI): 0.62 (0