2011加拿大心房颤动指南课件.ppt

* * * * * * * * * * * * * * * removed an extra “or” from column 3, third box from bottom * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Comparison - Prevention CCS Guidelines ESC Guidelines Strength LOE Class LOE BB continued if on Strong High I A BB started if not on Cond Low I A Amio if BB contraindicated Strong High IIa A Sotalol may be considered Cond Mod IIb A Bi-A Pace may be considered Cond Low IIb A IV Mag may be considered Cond Low -- -- Corticosteriods considered -- -- IIb B 0 10 20 Pts in hospital Days Post-Op rate rhythm 5 15 25 Lee JK et al. Am Heart J 2000;140:9:871-7. p = 0.27 30 35 RCT of Rate- vs Rhythm-Control Treatment of PAOF (N=50) 9.0 ± 0.7 days 13.2 ± 2.0 days p = 0.05 rate rhythm NSR at 8 weeks 91% 96% POAF - Treatment POAF - Treatment ?We suggest that consideration be given to anticoagulation therapy if post-operative continuous atrial fibrillation persists for more than 72 hours. This consideration will include individualized assessment of the risks of a thromboembolic event and the risk of post-operative bleeding. Conditional Recommendation Low Quality Evidence Values and Preferences: This recommendation places a higher value on minimizing the risk of thromboembolic events and a lower value on the potential for post-operative bleeding. Because the risk of post-operative bleeding decreases with time the benefit to risk ratio favours a longer period without anticoagulation in the post-operative setting than that suggested in other settings. We recommend that temporary epicardial pacing electrode wires be placed at the time of cardiac surgery to allow backup ventricular pacing as necessary. Strong Recommendation Low Quality Evidence We recommend that post operative AF with a rapid ventricular response be treated with a beta-blocker, a non-dihydropyridine calcium antagonist, or amiodarone to establish ventricular rate control. The specific agent