2010 ESC 房顫指南（英文）課件

EuropeanHeartJournal2010EuropeanHeartRhythmAssociation(EHRA);

EndorsedbytheEuropeanAssociationforCardio-ThoracicSurgery(EACTS)ESCGuidelines2010

onthemanagementof

AtrialFibrillationEuropeanHeartJournal(2010)31,2369-24292010ESC房顫指南英文2010ESC房顫指南英文Classesofrecommendations2010ESC房顫指南英文Levelsofevidence2010ESC房顫指南英文ClinicalEvents(outcomes)affectedbyAF2010ESC房顫指南英文Conditionspredisposingto,or

encouragingprogressionofAF2010ESC房顫指南英文TypesofAtrialFibrillation2010ESC房顫指南英文Clinicalevaluation2010ESC房顫指南英文StructuralabnormalitiesassociatedwithAF2010ESC房顫指南英文EHRAscoreofAF-

relatedsymptomsAF=atrialfibrillation;EHRA=EuropeanHeartRhythmAssociation2010ESC房顫指南英文NaturaltimecourseofAFAF=atrialfibrillation2010ESC房顫指南英文DiagnosisandinitialmanagementofAFaClassofrecommendation.bLevelofevidence.AF=atrialfibrillation;ECG=electrocardiogram;EHRA=EuropeanHeartRhythmAssociation.2010ESC房顫指南英文DiagnosisandinitialmanagementofAFaClassofrecommendation.bLevelofevidence.AF=atrialfibrillation;ECG=electrocardiogram.2010ESC房顫指南英文DiagnosisandinitialmanagementofAFaClassofrecommendation.bLevelofevidence.AF=atrialfibrillation;ECG=electrocardiogram.2010ESC房顫指南英文ThemanagementcascadeforpatientswithAFACEI=angiotensin-convertingenzymeinhibitor;AF=atrialfibrillation;ARB=angiotensinreceptorblocker;

PUFA=polyunsaturatedfattyacid;TE=thrombo-embolism.2010ESC房顫指南英文CHADS2scoreandstrokerate*Theadjustedstrokeratewasderivedfromthemultivariableanalysisassumingnoaspirinusage;thesestrokeratesare

basedondatafromacohortofhospitalisedAFpatients,publishedin2001,withlownumbersinthosewithaCHADS2score

of5and6toallowanaccuratejudgementoftheriskinthesepatients.Giventhatstrokeratesaredecliningoverall,actual

strokeratesincontemporarynon-hospitalisedcohortsmayalsovaryfromtheseestimates.AdaptedfromGageBFetal. AF=atrialfibrillation;CHADS2=cardiacfailure,hypertension,age,diabetes,stroke(doubled).2010ESC房顫指南英文Riskfactorsforstrokeand

thrombo-embolisminnon-valvularAFAF=atrialfibrillation;EF=ejectionfraction(asdocumentedbyechocardiography,radionuclideventriculography,cardiac

catheterization,cardiacmagneticresonanceimaging,etc.);LV=leftventricular;TIA=transientischaemicattack.2010ESC房顫指南英文Riskfactor-basedpoint-basedscoring

system-CHA2DS2-VASc

*Priormyocardialinfarction,peripheralarterydisease,aorticplaque.Actualratesofstrokeincontemporary

cohortsmayvaryfromtheseestimates.2010ESC房顫指南英文Adjustedstrokerateaccording

toCHA2DS2-VAScscore2010ESC房顫指南英文Useoforalanticoagulationfor

strokepreventioninAFAF=atrialfibrillation;OAC=oralanticoagulant;TIA=transientischaemicattack.2010ESC房顫指南英文ApproachtothromboprophylaxisinAFAF=atrialfibrillation;CHA2DS2-VASc=cardiacfailure,hypertension,age≥75(doubled),diabetes,stroke(doubled)-vasculardisease,age65–74andsexcategory(female);INR=internationalnormalizedratio;OAC=oralanticoagulation,suchasavitaminKantagonist(VKA)adjustedtoanintensityrangeofINR2.0–3.0(target2.5).2010ESC房顫指南英文TheHAS-BLEDbleedingriskscore*Hypertensionisdefinedassystolicbloodpressure>160mmHg.INR=internationalnormalizedratio.2010ESC房顫指南英文Cardioversion,TOEandanticoagulationAF=atrialfibrillation;DCC=directcurrentcardioversion;LA=leftatrium;LAA=leftatrialappendage;OAC=oralanticoagulant;

SR=sinusrhythm;TOE=transoesophagealechocardiography.2010ESC房顫指南英文PreventionofthromboembolisminAF2010ESC房顫指南英文PreventionofthromboembolisminAF2010ESC房顫指南英文aClassofrecommendation.bLevelofevidence.AF=atrialfibrillation;CHADS2=cardiacfailure,hypertension,age,diabetes,stroke(doubled);

INR=internationalnormalizedratio;LMWH=lowmolecularweightheparin;OAC=oralanticoagulant;TIA=transientischaemicattack;VKA=vitaminKantagonist.PreventionofthromboembolisminAF2010ESC房顫指南英文Drugsanddosesforpharmacological

conversionof(recent-onset)AF

ACS=acutecoronarysyndrome;AF=atrialfibrillation;DCC=directcurrentcardioversion;i.v.=intravenous;

N/A=notapplicable;NYHA,NewYorkHeartAssociation;p.o.=peros;QRS=QRSduration;QT=QTinterval;

T-U=abnormalrepolarization(T-U)waves.2010ESC房顫指南英文DCCandpharmacologicalconversion

recent-onsetAFAF=atrialfibrillation;i.v.=intravenous.2010ESC房顫指南英文PharmacologicalcardioversionofAFaClassofrecommendation.bLevelofevidence.AF=atrialfibrillation;LoE=levelofevidence;i.v.=intravenous.2010ESC房顫指南英文DCcardioversionforAFaClassofrecommendation.bLevelofevidence.AF=atrialfibrillation;DCC=directcurrentcardioversion.2010ESC房顫指南英文GeneralManagementoftheAFPatient2010ESC房顫指南英文Choiceofrateandrhythmcontrolstrategies2010ESC房顫指南英文RateandrhythmcontrolofAFaClassofrecommendation.bLevelofevidence.AF=atrialfibrillation;EHRA=EuropeanHeartRhythmAssociation.2010ESC房顫指南英文Optimallevelofheartratecontrol2010ESC房顫指南英文RatecontrolofatrialfibrillationThechoiceofdrugsdependsonlifestyleandunderlyingdisease2010ESC房顫指南英文Drugsfor

ratecontrolER=extendedreleaseformulations;N/A=notapplicable.?Onlyinpatientswithnon-permanentatrialfibrillation.2010ESC房顫指南英文AcuteratecontrolinAFaClassofrecommendation.bLevelofevidence.AF=atrialfibrillation;i.v.=intravenous.2010ESC房顫指南英文Long-termratecontrolinAF

aClassofrecommendation.bLevelofevidence.AF=atrialfibrillation;bmp=beatsperminute;LV=leftventricular;NYHA=NewYorkHeartAssociation.2010ESC房顫指南英文Long-termratecontrolinAF

aClassofrecommendation.bLevelofevidence.

AF=atrialfibrillation;bmp=beatsperminute;LV=leftventricular;NYHA=NewYorkHeartAssociation.2010ESC房顫指南英文AVnodeablationinAFpatientsaClassofrecommendation.bLevelofevidence.AF=atrialfibrillation;AV=atrioventricular;CRT=cardiacresynchronizationtherapy;LV=leftventricular;

LVEF=leftventricularejectionfraction;NYHA=NewYorkHeartAssociation.2010ESC房顫指南英文AVnodeablationinAFpatientsaClassofrecommendation.bLevelofevidence.AF=atrialfibrillation;AV=atrioventricular;CRT=cardiacresynchronization

therapy;LV=leftventricular;LVEF=leftventricularejectionfraction;NYHA=NewYorkHeartAssociation.2010ESC房顫指南英文Choiceofpacemakersafter

AVnodeablationaClassofrecommendation.bLevelofevidence.AF=atrialfibrillation;AV=atrioventricular;CRT=cardiacresynchronizationtherapy;LV=leftventricular;

LVEF=leftventricularejectionfraction;NYHA=NewYorkHeartAssociation.2010ESC房顫指南英文Principlesofantiarrhythmicdrug

therapytomaintainsinusrhythmTreatmentismotivatedbyattemptstoreduceAF-related

symptoms.Efficacyofantiarrhythmicdrugstomaintainsinusrhythmismodest.Clinicallysuccessfulantiarrhythmicdrugtherapymayreducerather

thaneliminaterecurrenceofAF.Ifoneantiarrhythmicdrug‘fails’aclinicallyacceptableresponse

maybeachievedwithanotheragent.Drug-inducedproarrhythmiaorextra-cardiacside-effectsare

frequent.Safetyratherthanefficacyconsiderationsshouldprimarilyguide

thechoiceofantiarrhythmicagent.2010ESC房顫指南英文Suggesteddosesandmaincaveatsfor

commonlyusedantiarrhythmicdrugsAF=atrialfibrillation;AV=atrioventricular;bpm=beatsperminute;CYP=cytochromeP;ECG=electrocardiogram;

LV=leftventricular;NYHA=NewYorkHeartAssociation.2010ESC房顫指南英文Suggesteddosesandmaincaveatsfor

commonlyusedantiarrhythmicdrugs

(Contd)AF=atrialfibrillation;AV=atrioventricular;bpm=beatsperminute;CYP=cytochromeP;ECG=electrocardiogram;

LV=leftventricular;NYHA=NewYorkHeartAssociation.2010ESC房顫指南英文Suggesteddosesandmaincaveatsfor

commonlyusedantiarrhythmicdrugs

(Contd)AF=atrialfibrillation;AV=atrioventricular;bpm=beatsperminute;CYP=cytochromeP;ECG=electrocardiogram;

LV=leftventricular;NYHA=NewYorkHeartAssociation.2010ESC房顫指南英文Choiceofantiarrhythmicforthepatient

withnoorminimalstructuralheartdisease2010ESC房顫指南英文Choiceofantiarrhythmicdrug

accordingtounderlyingpathologyACEI=angiotensin-convertingenzymeinhibitor;ARB=angiotensinreceptorblocker;CAD=coronaryarterydisease;CHF=congestiveheartfailure;

HT=hypertension;LVH=leftventricularhypertrophy;NYHA=NewYorkHeartAssociation;unstable=cardiacdecompensationwithintheprior

4weeks.Antiarrhythmicagentsarelistedinalphabeticalorderwithineachtreatmentbox.?=evidencefor‘upstream’therapyforpreventionofatrial

remodellingstillremainscontroversial.2010ESC房顫指南英文Choiceofanantiarrhythmicdrug

forAFcontrolaClassofrecommendation.bLevelofevidence.

AF=atrialfibrillation;AV=atrioventricular;LoE=levelofevidence;NYHA=NewYorkHeartAssociation.2010ESC房顫指南英文Choiceofanantiarrhythmicdrug

forAFcontrolaClassofrecommendation.bLevelofevidence.

AF=atrialfibrillation;AV=atrioventricular;LoE=levelofevidence;NYHA=NewYorkHeartAssociation.2010ESC房顫指南英文Choiceofanantiarrhythmicdrug

forAFcontrolaClassofrecommendation.bLevelofevidence.AF=atrialfibrillation;AV=atrioventricular;LoE=levelofevidence;NYHA=NewYorkHeartAssociation.2010ESC房顫指南英文Choicebetweenablationandantiarrhythmicdrugtherapy

forpatientswithandwithoutstructuralheartdisease?MoreextensiveLAablationmaybeneeded;*usuallyPVIisappropriate.

AF=atrialfibrillation;CAD=coronaryarterydisease;CHF=congestiveheartfailure;HT=hypertension;LVH=leftventricularhypertrophy;

NYHA=NewYorkHeartAssociation;PVI=pulmonaryveinisolation.Antiarrhythmicagentsarelistedinalphabeticalorderwithineachtreatmentbox.2010ESC房顫指南英文LeftatrialcatheterablationaClassofrecommendation.bLevelofevidence.AF=atrialfibrillation;i.v.=intravenous;LMWH=lowmolecularweight

heparin;OAC=oralanticoagulant;UFH=unfractionatedheparin.2010ESC房顫指南英文LeftatrialcatheterablationaClassofrecommendation.

bLevelofevidence.

AF=atrialfibrillation;i.v.=intravenous;LMWH=lowmolecularweightheparin;OAC=oralanticoagulant;

UFH=unfractionatedheparin.2010ESC房顫指南英文SurgicalablationofAFaClassofrecommendation.bLevelofevidence.AF=atrialfibrillation.2010ESC房顫指南英文PrimarypreventionofAF

with“upstream”therapyaClassofrecommendation.bLevelofevidence.ACEI=angiotensin-convertingenzymeinhibitor;AF=atrialfibrillation;ARB=angiotensinreceptorblocker.2010ESC房顫指南英文SecondarypreventionofAF

with“upstream”therapyaClassofrecommendation.bLevelofevidence.ACEI=angiotensin-convertingenzymeinhibitor;AF=atrialfibrillation;ARB=angiotensinreceptorblocker.2010ESC房顫指南英文RatecontrolduringAFwithheartfailureaClassofrecommendation.bLevelofevidence.AF=atrialfibrillation;AP=accessorypathway;LVEF=leftventricularejectionfraction.2010ESC房顫指南英文RatecontrolduringAFwithheartfailureaClassofrecommendation.bLevelofevidence.AF=atrialfibrillation;AV=atrioventricular;CRT=cardiacresynchronizationtherapy;

LVEF=leftventricularejectionfraction;NYHA=NewYorkHeartAssociation.2010ESC房顫指南英文RhythmcontrolofAFinheartfailureaClassofrecommendation.bLevelofevidence.AF=atrialfibrillation;DCC=directcurrentcardioversion;NYHA=NewYorkHeartAssociation.2010ESC房顫指南英文AtrialFibrillationinathletesaClassofrecommendation.bLevelofevidence.AF=atrialfibrillation.2010ESC房顫指南英文AtrialFibrillationinvalvularheartdiseaseaClassofrecommendation.bLevelofevidence.AF=atrialfibrillation;INR=internationalnormalizedratio;LA=leftatrial;LV=leftventricular.2010ESC房顫指南英文AtrialFibrillationin

acutecoronarysyndromesaClassofrecommendation.bLevelofevidence.AF=atrialfibrillation,ACS=acutecoronarysyndrome;DCC=directcurrentcardioversion.2010ESC房顫指南英文AtrialFibrillationin:aClassofrecommendation.bLevelofevidence.AF=atrialfibrillation,ECG=electrocardiogram.2010ESC房顫指南英文AtrialFibrillationinpregnancyaClassofrecommendation.bLevelofevidence.AF=atrialfibrillation;DCC=directcurrentcardioversion;LMWH=lowmolecularweightheparin;

UFH=unfractionatedheparin;VKA=vitaminKantagonist.20