1、房颤的认知和处理,房颤是一种常见的持续性心律失常，表现为心房激动的紊乱。 心电图特点： 1）P波消失，代之为大小、形态、间期极不规则的 f 波。 2）R-R间期极不规则。,创编:P波最好见于 v1，f波最好见于2导。,房颤的分类（“三P”法）阵发性(paroxysmal)房颤： 发作时间小于7天（大多数24小时）可自行转复，并反复发作。持续性(persistent)房颤： 通常发作大于7天(大多数48小时以上)，需要药物或非药物干预才能转复。永久性(permanent)房颤： 发作持续几天或几年，药物或非药物干预不能转复者。,First detected,Paroxysmal1,4(self-
2、termination),Persistent2,4(not self-terminating),permanent3,Figure:Patterns of atrial fibrillation. (1)episodes that generally lastLess than or equal to 7 days (most less than 24h; (2)Usually more Than 7 days; (3)Cardioversion failed or not atempted; and (4)eitherParoxysmal or persistent AF may be r
3、ecurrent.,孤立性房颤(“Lone AF”)： 年龄60 500 据肾功能，体重和年龄调 40-60 250 整剂量 20-40 125 20 禁用伊布利特 静脉 1mg 10分钟以上，必要时重复1mg QT延长，Tdp普罗帕酮 口服 450-600mg 低血压 静脉 1.5-2.0mg/kg 20分钟以上 房扑时房室传导加快奎尼丁 口服 0.75-1.5g分次服，6-12h以上，通 Q-T延长，Tdp、低血压、 常伴有频率减慢药物 胃肠道功能紊乱,Recommendations for pharmacological or electrical carioversion of AFC
4、lass I:1)Immediate electrical cardioversion in patients with paroxysmal AF and a rapid ventricular response who have ECG evidence of acute MI or symptomatic hypo- tension, angina, or HF that dose not respond promptly to pharmacological measures. (Level of evidnece:C) 2)Cardioversion in patients with
5、out haemodynamic instability when symptomsof AF are unacceptable. (Level of evidence:C),Class IIa: 1)Pharmacological or electrical cardioversion to accelerate restoration of sinus rhythm in patients with a first- detected episode of AF. (Level of evidence: C) (See Tables 6-8 for recommended drugs).
6、2)Electrical cardioversion in patients with persistent AF when early recurrence is unlikely. (Level of evidence:C) 3)Repeated cardioversion followed by prophylactic drug therapy in patients who relapse to AF without anti- arrhythmic medication after successful cardioversion. (Level of evidence:C),Cl
7、ass IIb: 1)Pharmacological agents for cardioversion to sinus rhythm in patients with persistent AF. (Level of evidence:C) (See Tables 6-8 for recommended drugs). 2)Out-of-hospital adminstration of pharmacological agents for cardioversion of first-detected, paroxysmal, or persistent AF in patients wi
8、thout heart disease or when the safety of the drug in the particular patient has been verified. (Level of evidence:C) (See Table 8).,Class III: 1)Electrical cardioversion in patients who display spontaneous alternation between AF and sinus rhythm over short periods of time. (Level of evidence:C) 2)A
9、dditional cardioversion in patients with short period of sinus rhythm who relapse to AF display multiple cardioversion procedures and prophy- lactic antiarrhythmic drug treatment. (Level of evidence:C),Table Typical doses of drugs used to maintain sinus rhythm in patients with atrial fibrillationDru
10、g* Daily dosage* Potential adverse effects Admiodaronet 100-400mg Photosensitivity, pulmonary toxicity,poly- neuropathy,GI upset,bradycaria,torsade de pointes (rare), hepatic toxicity,thyroid dysfunctionDisopyramide 400-750mg Torsade de pointes, HF, glaucoma, urinary retention, dry mouthDofetilide 5
11、00-1000ug Torsade de pointes Flecainide 200-300mg Ventricular tachycardia, congestive HF, enhanced AV nodal conduction (conversion to atrial flutter)Procainamide 1000-4000mg Torsade de pointes, lupus-like syndrome, GI symptomsPropafenone 450-900mg Ventricular tachycardia,congestive Hf, enhanced AV nodal conduction (conversion to atrial flutter)Quinidine 600-1500mg Torsade de pointes, GI upset, enhanced AV nodal conductionSotalol 240-320mg Torsade de pointes, congestive HF, bradycardia, exacer- bation of chronic obstructive of bronchospastic lung disease,
