房颤的认知和处理1__培训课件.ppt

NEWLY DISCOVERED AF Paroxysmal Persistent No therapy needed unless Severe symptome (e.g., Hypotension,HF,angina pectoris Accept Permenent AF Rate control and Anticoagulation As needed Anticoagulation As needed Anticoagulation And rate control* As needed Consider Antiarrhythmic Durg therapy Cardioversion Long-term Antiarrhythmic Drug therapy unnecessary RECURRENT PAROXYSMAL AF Minimal or no symptoms Disabling symptoms in AF Anticoagulation and rate control as needed Anticoagulation and rate control as needed No drug for prevention of AF Antiarrhythmic drug therapy* RECURRENT PERSISTENT AF PERMANENT AF Minimal or No symptoms Disablling Symptoms in AF Anticoagulation And rate control* As needed Anticoagulation And rate control Antiarrhythmic Drug therapy* Electrical Cardioversion as needed Continue Anticoagulation as Needed and therapy To maintain Sinus Rhythm* Anticoagulation And rate control* As needed ? 控制心室率： 药物治疗 射频消融房室结交界区+永久性人工心脏起搏 优点：1）仅采用控制心室率一项治疗措施，显著减轻 或消除症状； 2）与心律转复相比，控制心室率较易达到； 3）致室性心律失常作用少或无； 缺点：1）心室率仍不规则，仍有症状； 2）血流动力学有改善，但仍不完全； 3）药物引起心室率慢，需起搏器； 4）仍房颤，高危患者需抗凝。 控制心室率药物治疗： 房颤时一般用抑制房室结内传导和 延长其不应期的药物，以减慢心室率、 缓慢症状和改善血流动力学。 药物有：洋地黄类、?阻滞剂和胺碘 酮或索他洛尔。 Table Intravenous pharmacological agents for heart rate control in patients with AF Drug* Loading dose Onset Maintenance dose Major side effects Class recommendation Diltiazem 0.25mg/kg IV 2-7min 5-15mg per hour in- Hypotension, heart I over 2min fusion block,Hf Esmolol 0.5mg/kg over 5min 0.05-0.2mg.kg-1min Hypotension,heart I