非抗心律失常药物对房颤的治疗PPT课件.ppt

《非抗心律失常药物对房颤的治疗PPT课件.ppt》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、非抗心律失常药物对房颤的预防作用南京医科大学第一附属医院心内科单其俊AFGrandfatherofarrhythmia;Grandfather’sarrhythmia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。ClassificationofatrialfibrillationWGA-ESC&NASPEJUNE13,2000TerminologyClinicalFeaturesArrhythmiaPatternTherapeuticI

2、mplicationInitialevent(firstdetectedepisode)SymptomaticAsymptomatic(firstdetected)Onsetunknown(firstdetected)MayormaynotrecurAntiarrhythmictherapyforpreventionisnotneededexceptifsymptomsaresevereParoxysmalSpontaneoustermination<7daysandmostoften<48hoursR

3、ecurrentPreventionofrecurrencesRatecontrolandanticoagrlationifneededpersistentNotself-termimatingLasting>7daysorpriorcardioversionRecurrentRatecontrolandanticoagrlationifneededor/andcardioversionandprophylacticantiarrhythmictherapyPermanent(accepted)Nott

4、erminatedTerminatedbutrelapsedNocardioversionattemptestablishedRatecontrolandanticoagrlationasneeded房颤临床表现的多样性房颤观察的时间窗SR10~15年AFAPC;AT;PSVT;AFL?ElectricalremodelingTachyinducedtachySinusbegetssinusAFbegetsAFStructuralremodeling致心律失常基质？HT，CHF，CHD，DM….遗传学家

5、族性房颤BrugadaShortQT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

6、致心律失常作用，包括致命性的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？现代房颤的机制AtrialElectrical&Structuralremodeling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motherrotors、二尖峡部、mashalllig.等）多小波折返右房被动（三尖瓣和下腔静脉峡部）Electricalremodelingincludede

7、creasedatrialeffectiverefractoryperiod(ERP)andreducedERPrate-adaptation.Conductionvelocityalsodecreases,butmoreslowly.AFbegetsAFSinusbegetssinusTachyinducedtachyPulmonaryveinsmusclesleeveFigure1.APD90sadaptationtorateinPAFandControlgroups.Theyellowsquare

8、representsControlgroupandtheredrepresentsPAFgroup.*meansp<0.05******StructuralremodelingAFisassociatedwithatrialdilation,lostofatrialcontraction,andmitralinsufficiency-socalled“atrialstructuralremodeling”Atrialcardiomyopat