2011 ACCF房颤治疗指南更新解读.pptVIP

2011 ACCF/AHA/HRS Focused Update on Management of Pts With AF (Updating the 2006 Guideline) Chenqi Depart of Cardiology, 2nd Affil Hosp to NCU Focuses on several areas a) recommendations for strict versus lenient heart rate control b) combined use of antiplatelet and anticoagulant therapy c) use of dronedarone d) catheter ablation of AF I. Rate Control During AF Rate Control During AF Rate reduction has several benifits Some pts with AF Ventricular rate is well controlled at rest but accelerate during exercise Parameters for optimal rate control remain controversial Criteria for ventricular rate control vary with age usually 60-80 bpm at rest 90-115 bpm during moderate exercise If the fact does favouring strict rate control? RACE II study Rate Control Efficacy in Permanent AF Hypothesis Primary endpoints Conclusions of RACE II Limits Pts included Relatively young (mean 68 yr) Compared to pts encountered in clinic Be healthier Be less symptomatic Recommendation for Rate Control---NEW!! 2011 Focused Update Recommendation Class III–No Benefit 1. Treatment to achieve strict rate control of heart rate (80 bpm at rest or 110 bpm during a 6-minute walk) is not beneficial compared to achieving a resting heart rate 110 bpm in patients with persistent AF who have stable ventricular function (EF0.40) and no or acceptable symptoms related to the arrhythmia, though uncontrolled tachycardia may over time be associated with a reversible decline in ventricular performance.3 (Level of Evidence: B) II. Combining AnticoagulantWith Antiplatelet Therapy Combining AnticoagulantWith Antiplatelet Therapy warfarin is effective for prevention of thromboembolism in AF pts ASA offers only modest protection Recent studies assessed clopidogrel + ASA for stroke prevention in AF ACTIVE-W ACTIVE-A ACTIVE W: Treatments Outcome Events Stroke, Non-CNS Systemic Embolism, MI Vascular Death Primary Outcome Components Death Major Bleeding Early Termination of ACTIVE W Conclusions