心房颤动指南解读（华化令）2 课件.ppt

有效抗凝 出血并发症 INR （2.0-3.0）） 积极治疗高血压和糖尿病 Active A, W, and I Documented AFRisk Factor(s) for Vascular EventsNo exclusion criteria for ACTIVE Eligible for ACTIVE A(double-blind trial 7500 patients)Clopidogrel 75 mg/d plus ASAvs ASA Mean Follow-up 3 Years Eligible for ACTIVE W(non-inferiority trial 6500 patients) Clopidogrel 75 mg/d plus ASA vs anticoagulation – INR 2.0-3.0 No Exclusion Criteria for ACTIVE I Recommended doseof ASA: 75-100 mg/d Eligible for ACTIVE I(double-blind trial approximately 9000 patients)(Irbesartan 300 mg/d vs placebo) Partial Factorial Design Contra-indication to anticoagulation/unwilling to take anticoagulation ACTIVE Investigators. Am Heart J. 2006;151:1187-1193. Use of oral anticoagulation forstroke prevention in AF AF = atrial fibrillation; OAC = oral anticoagulant; TIA = transient ischaemic attack. The HAS-BLED bleeding risk score *Hypertension is defined as systolic blood pressure 160 mmHg. INR = international normalized ratio. Cardioversion, TOE and anticoagulation AF = atrial fibrillation; DCC = direct current cardioversion; LA = left atrium; LAA = left atrial appendage; OAC = oral anticoagulant;SR= sinus rhythm; TOE= transoesophageal echocardiography. DCC and pharmacological conversion recent-onset AF AF = atrial fibrillation; i.v. = intravenous. Rate control of atrial fibrillation The choice of drugs depends on life style and underlying disease Choice of rate and rhythm control strategies Optimal level of heart rate control Candidates Recognized acute and recent onset No AAD risk markers Adequate tolerance (no pulmonary edema, syncope, etc) “Pill in the Pocket” Acute load on chronic therapy 2 extra “pill in the pocket” dosing regimens have been used to treat breakthrough episodes (max. daily dose vs substitute bolus dose)a Alboni P, et al. N Engl J Med. 2004;351(23):2384-2391. aReiffel JA. Pacing Clin Electrophysiol. 2009;32(8):1073-1084. Step 1 Step 2 Step 3 Rate control (~100 bpm) to prevent 1:1 flutter