房颤的进展复习课程.ppt

结果发现，患者年度卒中或全身性血管栓塞的发生率在阿哌沙班组显著低于阿司匹林组，危险性降低一半以上。 * 每日服用阿司匹林相比，使用口服Xa因子抑制剂阿哌沙班可将发生卒中或全身性血管栓塞的危险性降低一半以上， 但难能可贵的是，阿哌沙班组并不增加大出血的危险性 * 试验结果分析表明，1000名患者使用apixaban替代阿司匹林治疗１年， 可以减少18例卒中、10例死亡和31例心血管住院事件，代价则可能是增加2名大出血的患者。?可见其获益远大于风险。 * Dr Connolly 对该研究结果评论道，“AVERROES研究结果令人惊喜，阿哌沙班在降低卒中和系统性栓塞风险的同时，增加出血的风险很小，这一点非常重要。看来阿哌沙班将成为那些有房颤但不适合服用华法林患者治疗的最佳选择。” * 做为一线治疗的选择，在实践中需要充分考虑以下方面：（1）心房疾病的程度（房颤类型，左心房大小，症状的严重程度等），（2）伴发心血管疾病的严重程度，（3）患者的意愿，（4）医生的经验。ACCF 2011指南中虽然未强调一线治疗的问题，但是将导管消融的推荐级别从IIa级提高到I级。值得一提的是，欧美指南均指出了进行导管消融的医疗中心和医生的经验对导管消融成功率和并发症会有所影响。 * * ECG #4 Clinical Information: This 58-year old woman presented to an emergency department with palpitations and shortness of breath. ECG Findings: The ECG shows atrial flutter at a rate of 290 bpm with 2:1 AV block. Two aberrant beats are present which are probably ventricular in origin. * * * * * * * * * * Dronedarone is added in parentheses here as a possible position in this table where it may become recommended in future guidelines statements. * The importance of firing from muscle sleeves extending into the pulmonary veins has been well established by Haissaguerre and collaborators over the past 10years and that ablation of these targets can maintain SR. In addition to pulmonary vein triggers, non-PV triggers may be present as well, including from the SVC and CS. Focal triggers can lead to reentry in high frequency rotors, and electrical activation from these rotors may fragment giving fibrillatory conduction. If this process continues for long periods, there is subsequent atrial remodeling at the cellular level (ion channels) and other triggers arise further perpetuating AF, in particular small and large reentrant wavelets. The multiple wavelet hypothesis (Moe) states that AF is the result of a critical number of multiple reentrant wavelet circuits appearing simultaneously, as a function of conduction velocity, atrial refractory period and mass. AF will continue if conduction velocity is slow and refractory periods are short