2014_ACC房颤指南解读.pptVIP

指南的数个段落提到了经皮左心耳封堵装置，但未给予正式推荐。 2014 AHA/ACC/HRS 心房颤动患者管理指南解读 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 60 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 non–AF-related stroke. AF 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 LAA may be considered in patients undergoing cardiac surgery. (Level of Evidence: C) 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 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) 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 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