心律失常药物治疗-(2).pptVIP

ESC2012 心衰合并室性心律失常患者应去除诱因，如电解质紊乱，应用的致心律失常药物，心肌缺血。 (Ⅰ、C) 选用ACE/ARB、β-受体阻滞剂以及醛固酮拮抗剂作为心衰合并室性心律失常患者的理想治疗(Ⅰ、A) 对冠心病引起心律失常的患者应考虑血运重建 (Ⅰ、C) 病因 老龄 高血压 症状性心衰 心肌病 瓣膜性心脏病 先天性心脏病（房缺） 冠心病 甲状腺疾病（亚临床甲减） 肥胖 糖尿病 COPD 呼吸睡眠暂停综合征 慢性肾病 治疗目标 三升三降： 根据生活方式及潜在疾病情况选择药物 新发房颤转复治疗 导管消融和维持窦律的药物选择 上游治疗作为房颤一级预防的建议 ACEI及ARB适用于心衰、射血分数降低患者初发房颤的预防(Ⅱa/A) ACEI及ARB适用于高血压，特别是合并左室肥厚患者，初发房颤的预防(Ⅱa/B) 他汀类药物适用于冠脉搭桥术，合并或不合并瓣膜置换患者，初发房颤的预防(Ⅱa/B) 他汀类药物适用于有器质性心脏病、特别是心衰的患者，初发房颤的预防(Ⅱb/B) 无心血管疾病的房颤患者，不建议应用ACEI、ARB及他汀类药物作为上游治疗，进行房颤的一级预防(Ⅲ/C) 上游治疗作为房颤二级预防的建议 电复律及抗心律失常药物转复的反复发作的房颤，可以应用ACEI及ARB进行二级预防(Ⅱb/B) 无器质性心脏病的阵发性房颤或持续性房颤患者，若有其他的适应证(如高血压),ACEI或ARB可用于预防房颤(Ⅱb/B) Patients with AF therefore represent a vast population at high risk of stroke and, in particular, severe stroke. These patients are an important target population for reducing the overall burden of stroke. To prevent AF-related stroke, the ideal would be to prevent of reverse AF itself. Current techniques can only prevent AF in some patient. Hence, there is a clear need to improve detection and therapy of AF. For stroke prevention in AF the guideline-recommend the use of anticlotting drug therapy also known as anticoagulation therapy such as Aspirin and/or vitamin k antagonists. The type of anticoagulation therapy depends on the individual patient’s magnitude of risk. Various schema are available for evaluating stroke risk in AF, CHADS2 being the scheme probably used most frequently in routine practice. A cumulative CHADS2 score (range 1 to 6) is calculated by assigning points, and risk assessed accordingly, as shown in the slide. The current guidelines recommend Aspirin for patients at low risk, Aspirin or vitamin k antagonists for patients at moderate risk, and vitamin k antagonists for patients at moderate-to-high risk of stroke REFERENCES Gage et al. Validation of clinical classification schemes for predicting stroke. Results from the National Registry of Atrial Fibrillation. JAMA 2001;285:2864–2870. Gage et al. Selecting patients with atrial fibrillat