房颤的急诊处理—培训课件.ppt

心房颤动合并血栓栓塞的危险因素 非瓣膜性AF患者卒中和体循环栓塞的危险因素 ——以前有过卒中或短暂性脑缺血 ——高血压、 ——左室功能不全或充血性心力衰竭 ——高龄(高于75岁)， ——糖尿病和冠状动脉疾病史? 治疗策略 使用胺碘酮可以降低室率，但也可能转复。要做转复的准备 鉴于胺碘酮可能转复，应该使用普通肝素后接华法林 在急诊情况下行食管超声一般不现实 获益/风险 指南/实践 谢 谢！ * Several questions remain to be answered about rate control therapy in AF. These include how to best measure successful therapy and what is the optimal heart rate. Current guidelines define adequate rate control in AF as maintenance of the ventricular rate response between 60 and 80 beats per minute at rest and 90 and 115 beats per minute during moderate exercise.1 However, no controlled clinical trials have validated these values for preventing all-cause cardiovascular morbidity or mortality and such recommendations may be flawed for a number of reasons including the absence of atrial contraction and altered cardiac haemodynamics, resulting from fast and irregular ventricular rates. Little appreciation has been given so far to the fact that adequate rate control encompasses more than the mere prevention of fast ventricular rates. Few systematic studies explored the effect of rate slowing drugs on chronotropic competence in AF or define upper limits of the appropriate ventricular rate response during exercise. The effect of excessively irregular rhythm is rarely acknowledged in practice as an important constituent of effective rate control. Reference: 1. Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Le Heuzey JY, Kay GN, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann S, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Antman EM, Halperin JL, Hunt SA, Nishimura R, Ornato JP, Page RL, Riegel B, Priori SG, Blanc JJ, Budaj A, Camm AJ, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL; American College of Cardiology; American Heart Association Task Force; European Society of Cardiology Committee for Practice Guidelines; European