房颤转律(英文）.ppt

Cardioversion of Atrial FibrillationClinical Issues Cardioversion of Atrial FibrillationClinical Issues When and why cardiovert? Why not wait for spontaneous cardioversion? When and why acutely cardiovert? How to acutely cardiovert Electrical Pharmacologic Both AFFIRMBaseline Characteristics Age = 69.7 ± 9.0 yrs 39% female 2 days of AF in 69% CHF class II in 9% Symptomatic AF in 88% Trials of Rate vs Rhythm Control Implications of Trials: Guideline Statement Theoretically, rhythm control should have advantages over rate control, yet a trend toward lower mortality was observed in the rate-control arm of the AFFIRM study and did not differ in the other trials from the outcome with the rhythm control strategy. This might suggest that attempts to restore sinus rhythm with presently available antiarrhythmic drugs are obsolete. The RACE and AFFIRM trials did not address AF in younger, symptomatic patients with little underlying heart disease, in whom restoration of sinus rhythm by cardioversion antiarrhythmic drugs or non-pharmacological interventions still must be considered a useful therapeutic approach. One may conclude from these studies that rate control is a reasonable strategy in elderly patients with minimal symptoms related to AF. An effective method for maintaining sinus rhythm with fewer side effects would address a presently unmet need. AF Begets AF Paroxysmal AF 48 hours (n=100)Amiodarone IV (3 gm) vs IV placebo Likelihood of Spontaneous Conversion of Atrial Fibrillation to Sinus Rhythm Spontaneous Conversion of Patients with AF Scheduled for Electrical CardioversionAn ACUTE Trial Ancillary Study Spontaneous Conversion of Patients with AF Scheduled for Electrical CardioversionAn ACUTE Trial Ancillary Study Conversion of Recent-Onset AF to Sinus Rhythm: Effects of Different Drug Protocols Predictors of Cardioversion with Ibutilide201 patients treated AF 7 to 360 days duration (110 average) CHF, recent MI, bradycardia excluded Rhythm or rate control