非抗心律失常药物对房颤的治疗PPT优选课件

SR
10~15年
AF
APC ;AT;PSVT; AFL?
2020/10/18
5
影响现代心脏病临床实践最重要因素
介入心脏病学 循证医学
2020/10/18
6
现代房颤治疗的基础(一)
房颤常常与年龄有关.在美国大约50％房颤病人为 75岁以上的老人
无心脏瓣膜的房颤病人，体循栓塞和中风的发生 率较常人高5倍
Permanent (accepted)
Not terminated Terminated but relapsed No cardioversion attempt
established
Rate control and anticoagrlation as needed
房颤临床表现的多样性
2020/10/18
4
房颤观察的时间窗
致心律失常基质？ HT，CHF，CHD，DM…. 遗传学 家族性房颤
Brugada Short QT
Electrical remodeling Structural remodeling Tachy induced tachy Sinus begets sinus AF begets AF
动物模型研究表明房颤的机制可能有几种 心房的电重构与结构重构 节律控制和心率控制(>65岁)同样有效 射频导管消融可根治部分房颤 针对结构重构的非抗心律失常药物？
2020/10/18
8
现代房颤的机制
Atrial Electrical & Structural remodeling
左房驱动（触发+折返基质）（肺静脉有P细胞， 肺静脉内折返，左房与肺静脉交界处 mother rotors、二尖峡部、mashall lig. 等）
Recurrent
persistent
Not self-termimating
Lasting >7 days or prior cardioversion
Recurrent
Antiarrhythmic therapy for prevention is not needed except if symptoms are severe
Symptomatic
May or may not
(first detected episode) Asymptomatic (first detected) recur
Onset unknown (first detected)
Paroxysmal
Spontaneous termination< 7days and most often <48 hours
AF begets AF Sinus begets sinus Tachy induced tachy Pulmonary veins muscle sleeve
2020/10/18
10
APD90(ms)
280
260
240
220
AF
200
* **
Control
180
160
140 * * *
2020/10/18
11
Structural remodeling
AF is associated with atrial dilation, lost of atrial contraction, and mitral insufficiency-so called “atrial structural remodeling”
多小波折返 右房被动（三尖瓣和下腔静脉峡部）
2020/10/18
9
Electrical remodeling
include decreased atrial effective refractory period(ERP) and reduced ERP rate-adaptation. Conduction velocity also decreases, but more slowly.
3
Classification of atrial fibrillation
WGA-ESC &NASPE JUNE 13, 2000
Terminology
Clinical Features
Arrhythmia Pattern Therapeutic Implication
Initial event
华法林治疗维持INR2－3倍能非常有效在降低栓塞 和中风的发生率
房颤心室率控制不当可引起扩张型心肌病
药物不能有效地控制心室率，消融房室结或希氏 束加永久起搏
目前尚无一种药物能效地抑制房颤
2020/10/18
7
现代房颤治疗的基础(二)
尽管用抗心律失常药物治疗仍有半数的房颤病 人会复发
抗心律常药物治疗可能引起致心律失常作用， 包括致命性的
非抗心律失常药物对房颤的 预防作用
2020/10/18
1
AF Grandfather of
arrhythmia; Grandfather’s
arrhythmia
2020/10/18
2
心房颤动危害
（1）症状，如心悸、胸闷甚至晕厥 （2）引起或加重心功能不全； （3）血栓栓塞，如中风、体循栓塞等。
2020/10/18
Prevention of recຫໍສະໝຸດ Baidurrences Rate control and anticoagrlation if needed
Rate control and anticoagrlation if needed or / and cardioversion and prophylactic antiarrhythmic therapy
Atrial cardiomyopathy
2020/10/18
12
印度大象生下来就发房颤 小麻雀永远不会发生房颤
2020/10/18
13
Relationship of Atrial Electrical &
120
280 300 340 380 420 460 500 550 600 CLs(ms)
Figure 1.APD90s adaptation to rate in PAF and Control groups.The yellow square represents Control group and the red represents PAF group. * means p<0.05