Fibrillation心房纤颤（英文版）ppt课件.pptVIP

Why to Treat AF “AF begets AF” After 24 hours AF inducibility by a single premature stimulus increased from 24% to 76%. Goats kept in AF 2-4 weeks then sinus rhythm restored. Why to Treat AF “AF begets AF” Six hours after cardioversion, mean fibrillation interval increased from 105?10 ms to 139?7 ms. After 24 hours it had increased to baseline of 151?25 ms. AERP began to improve within 24 hours and normalized within one week. Why to Treat AF “AF begets AF” Single stimulus inducibility of AF decreased to 46% within 24 hours of conversion and to 29% within one week. Why to Treat AF Direct evidence for maintaining sinus rhythm is scarce. Three trials currently investigating this. 1) RACE 2) PIAF 3) AFFIRM Why to Treat AF RACE (Rate Control versus Electrical Cardioversion) Study in The Netherlands 500 patients randomized to rate control versus electrical cardioversion Primary endpoint combined morbidity and mortality Why to Treat AF PIAF (Pharmacologic Intervention in Atrial Fibrillation) Study in Germany 252 patients with symptomatic persistent AF of 7 to 360 days duration randomized to rate control versus pharmacologic conversion. Patients to be followed for 12 months Why to Treat AF PIAF (Con’t) Primary endpoint of recurrent tachycardia in rate control arm and recurrent AF in conversion arm. Secondary endpoints of quality of life (assessed by a structured questionnaire), hemodynamic consequences of therapy, thromboembolic complications and mortality will also be evaluated. Why to Treat AF AFFIRM (Atrial Fibrillation Follow-up of Rhythm Management) Sponsored by NHLBI 5,300 patients at high risk for stroke to be randomized to rate control or rhythm control (all patients to be anticoagulated) Drug choice to be left up to treating physician Why to Treat AF AFFIRM (Con’t) Patients to be followed a minimum of two years and an average of 3.5 years. Endpoints to be evaluated include total mortality, disabling stroke, disabling anoxic encephalopathy, intracranial bleedi