心房颤动与脑卒中课件.pptVIP

药物治疗理想目标与现实的差距 针对病因、诱因治疗 房颤发生的不可逆性病因多 节律控制治疗 应用抗心律失常药物，以转复房颤，恢复窦性心律为目的，复发率高，药物不良反应多。 室率控制治疗 治疗目的为：不追求转复房颤，仅以控制心室率，减轻症状，栓塞风险长期伴存。 抗凝，预防栓塞并发症治疗 华法林使用率极低，脑卒中发生率高是我国房颤病人的重要特点 节律控制—环肺静脉导管消融 阵发性房颤---90%成功率 慢性房颤-------70-80%成功率 房颤导管消融2010指南 药物治疗无效、有明显症状的阵发性房颤建议行导管消融（Ⅱa,A）； 药物治疗无效、有明显症状的持续性房颤，可考虑行导管消融（Ⅱa,B）； 对于合并心衰的房颤患者，包括胺碘酮在内的药物不能控制症状时考虑导管消融（Ⅱb,B）； 新指南首次提出了对于无严重潜在心脏疾病的阵发性房颤，若心率控制无效可在AAD治疗之前直接行导管消融（Ⅱb,B）； 有症状的长程持续性房颤，若AAD治疗无效，亦可考虑导管消融（Ⅱb, C）。 房颤导管消融适应证 ACC/AHA/ESC/CSPE指南 对于年龄75岁 无或轻度器质性心脏疾患 左心房直径50mm 反复发作的阵发性房颤患者 持续性房颤患者，心功能≤Ⅱ级 房颤卒中预防关注从“心”开始让我们一起携手安抚每一颗颤动的心 * New method of predicting stroke in heart patients St. Louis, June 13, 2001 — Researchers at Washington University School of Medicine in St. Louis have developed a formula to predict the risk of stroke in patients with an irregular heart rhythm called atrial fibrillation. “Our hope is that this new classification scheme will help physicians select the appropriate course of treatment for patients with atrial fibrillation,” says Brian F. Gage, M.D., who led the study. Gage is assistant professor of medicine at the School of Medicine and medical director of Barnes-Jewish Hospital’s blood thinner clinic. The results are published in the June 13 issue of the Journal of the American Medical Association. Patients with atrial fibrillation, an irregular, uncoordinated contraction of heart muscles, are estimated to have a fivefold increased risk of stroke. A blood thinner called warfarin sodium (sold as Coumadin? and others) often is used to reduce this risk, but the drug itself can cause hemorrhage and other side effects. It also is more expensive and more difficult to administer and monitor than the alternative treatment, aspirin. To help predict when the benefits of warfarin outweigh the risks, two earlier studies completed by two other research groups determined independent factors that significantly increase the risk of stroke. However, the studies reached somewhat different conclusions: The Atrial