资源描述：
《房颤转律（英文）》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。
1、CardioversionofAtrialFibrillation ClinicalIssuesChristopherGranger,MDDirector,CardiacCareUnitDukeUniversityMedicalCenterDecember2007CardioversionofAtrialFibrillation ClinicalIssuesWhenandwhycardiovert?Whynotwaitforspontaneouscardioversion?Whenandwhyacutelycardiovert?Ho
2、wtoacutelycardiovertElectricalPharmacologicBothAFFIRM BaselineCharacteristicsAge=69.7±9.0yrs39%female>2daysofAFin69%CHFclass>IIin9%SymptomaticAFin88%RateControlversusElectricalCardioversionforPersistentAtrialFibrillation(RACE)Trial(n=522)VanGelder,I.etal.NEnglJMed2002;
3、347:1834-1840CVdeath,HF,thromboemboliccomplications,bleeding,pacemaker,andSAEs.TrialsofRatevsRhythmControlACC/AHA/ESCGuidelines2006ImplicationsofTrials:GuidelineStatementTheoretically,rhythmcontrolshouldhaveadvantagesoverratecontrol,yetatrendtowardlowermortalitywasobse
4、rvedintherate-controlarmoftheAFFIRMstudyanddidnotdifferintheothertrialsfromtheoutcomewiththerhythmcontrolstrategy.Thismightsuggestthatattemptstorestoresinusrhythmwithpresentlyavailableantiarrhythmicdrugsareobsolete.TheRACEandAFFIRMtrialsdidnotaddressAFinyounger,symptom
5、aticpatientswithlittleunderlyingheartdisease,inwhomrestorationofsinusrhythmbycardioversionantiarrhythmicdrugsornon-pharmacologicalinterventionsstillmustbeconsideredausefultherapeuticapproach.Onemayconcludefromthesestudiesthatratecontrolisareasonablestrategyinelderlypat
6、ientswithminimalsymptomsrelatedtoAF.Aneffectivemethodformaintainingsinusrhythmwithfewersideeffectswouldaddressapresentlyunmetneed.ACC/AHA/ESCGuidelines2006ResultsNodifferenceinprimaryendpointofCVdeathbetweengroups(Figure)Cardioversion39%vs8%Alsonodifferenceintotalmorta
7、lity(31.8%vs.32.9%,p=0.73),stroke(2.6%vs.3.6%,p=0.32),worseningheartfailure(27.6%vs.30.8%,p=0.17),orcomposite(42.7%vs.45.8%,p=0.20)Higherhospitalizationrates(46%vs39%p=.006)andcostwithrhythmcontrolBradyarrhythmias↑inrhythmcontrolgroupConclusionsAmongpatientswithheartfa
8、ilureandatrialfibrillation,useofrhythmcontrolwasnotassociatedwithdifferencesinCVmortalitycomparedwithratecontrolResul
