心房颤动的治疗 新的循证医学证据——英文课件.ppt

Prevalence of AF is increasing Prevalence of AF is increasing Identified AF：the tip of the iceberg 14802 pts aged 65 or over，randomized to systemic screening and opportunistic screening Systemic screening group:9866 pts. Opportunistic screening group: 4936 pts. F/U 12 mons Rate of new AF case in systemic screening 1.63%， Rate of new AF case in opportunistic screening 1.04% Real world of warfarin in the elderly Prospective，randomize，control 973 pts ?75 years old with AF Randomized into warfarin arm (INR 2.0-3.0) and Aspirin arm(75mg/d) Mean F/U 2.7 yrs Primary outcome：fatal or disabling stroke, intracranial haemorrhage, or arterial embolism Anticoagulation in clinical practice Prospective RIKS-HIA 60764 pts，AF 21459 pts,CHF 22345 pts,AF+CHF16960 pts F/U 1 yr Higher mortality rate in AF without CHF pts taking digoxin (RR1.42) Similar mortality rate in CHF or AF+CHF pts with or without digoxin Adverse effects of oral amiodarone Amiodarone increased mortality of HF SCD－HeFT研究 Dronedarone：Substitution of amiodarone？ Derivative of amiodarone, not composed of iodine Eliminate the effects of amiodarone on thyroid and pulmonary functions Half-time 24 hours Catheter ablation is superior to antiarrhythmic durg A prospective, multicenter, randomized, controlled study APAF Trial Catheter ablation decrease the incidence of stroke N=589 Indications for catheter ablation The presence of symptomatic AF refractory or intolerant to at least one Class 1 or 3 antiarrhythmic medication in rare clinical situations, it may be appropriate to perform catheter ablation of AF as first line therapy selected symptomatic patients with heart failure and/or reduced ejection fraction LA thrombus is a contraindication AF Ablation as first-line therapy?(Catheter Ablation vs. Antiarrhythmic Drug Therapyfor Atrial Fibrillation Trial, CABANA) Ongoing NIH sponsored CABANA study: mortality study of AF ablation vs. antiarrhythmics vs. rate control/coumadin as first-line therapy for