心房顫動治療指引之簡介

10.6666/ClinMed.2017.80.6.130

鄭文涵；趙子凡；林彥璋

心房顫動 ； 中風 ； 出血 ； 導管電燒

臨床醫學月刊

80卷6期（2017 / 12 / 29）

716 - 721

繁體中文

全世界心房顫動的盛行率逐年增加，對於其產生的併發症也越來越重視。新興藥物治療與非藥物治療的進展日新月異，許多副作用較低，但效果較高的治療方式提供了更多選擇。因此，及早診斷心房顫動並加以治療為當今重要的課題。根據2016年歐洲心臟科醫學會心房顫動治療指引，治療方面的原則為預防中風的產生，心跳速率的控制及正常心律的維持。預防中風方面，透過CHA_2DS_2-VASc的危險因子分析，除了傳統的vitamin K拮抗劑，新型口服抗凝血劑提供了更少的出血機會與相當的預防中風效果。心跳速率與正常心律的維持目的在於利用低副作用的藥物治療，達到減緩病患症狀的效果。在藥物控制反應不甚良好的病患，導管電燒是可以考慮的選擇之一。其他像是心臟手術及其他非藥物治療的選擇也可提供特定病患的治療效果。

1. Bash, LD,Buono, JL,Davies, GM(2012).Systematic reviewand meta-analysis of the efficacy of cardioversion by vernakalant and comparators in patients with atrial fibrillation.Cardiovasc Drugs Ther,26,167-179.
2. Camm, AJ,Capucci, A,Hohnloser, SH(2011).A randomized active-controlled study comparing the efficacy and safety of vernakalant to amiodarone in recent-onset atrial fibrillation.J Am Coll Cardiol,57,313-321.
3. Chatterjee, S,Sardar, P,Lichstein, E(2013).Pharmacologic rate versus rhythm-control strategies in atrial fibrillation: an updated comprehensive review and meta-analysis.PACE,36,122-133.
4. Chevalier, P,Durand-Dubief, A,Burri, H(2003).Amiodarone versus placebo and class Ic drugs for cardioversion of recent-onset atrial fibrillation: a meta-analysis.J Am Coll Cardiol,41,255-262.
5. de Denus, S,Sanoski, CA,Carlsson, J(2005).Rate vs rhythm control in patients with atrial fibrillation: a meta-analysis.Arch Intern Med,165,258-262.
6. Fox, CS,Parise, H,D´Agostino, RB, Sr(2004).Parental atrial fibrillation as a risk factor for atrial fibrillation in offspring.JAMA,291,2851-2588.
7. Gage, BF,Yan, Y,Milligan, PE(2006).Clinical classification schemes for predicting hemorrhage: results from The National Registry of Atrial Fibrillation (NRAF).Am Heart J,151,713-719.
8. Gorst-Rasmussen, A,Skjoth, F,Larsen, TB(2015).Dabigatran adherence in atrial fibrillation patients during the first year after diagnosis: a nationwide cohort study.J Thromb Haemost,13,495-504.
9. Gudbjartsson, DF,Arnar, DO,Helgadottir, A(2007).Variants conferring risk of atrial fibrillation on chromosome 4q25.Nature,448,353-357.
10. Hou, ZY,Chang, MS,Chen, CY(1995).Acute treatment of recent-onset atrial fibrillation and flutter with a tailored dosing regimen of intravenous amiodarone. A randomized, digoxin- controlled study.Eur Heart J,16,521-528.
11. Klein, AL,Grimm, RA,Murray, RD(2001).Use of transesophageal echocardiography to guide cardioversion in patients with atrial fibrillation.N Engl J Med,344,1411-1420.
12. Kong, MH,Shaw, LK,O´Connor, C,Califf, RM,Blazing, MA,Al-Khatib, SM(2010).Is rhythm control superior to rate-control in patients with atrial fibrillation and diastolic heart failure?.Ann Noninvasive Electrocardiol,15,209-217.
13. Kotecha, D,Kirchhof, P(2014).Rate and rhythm control have comparable effects on mortality and stroke in atrial fibrillation but better data are needed.Evid Based Med,19,222-223.
14. Kowey, PR,Dorian, P,Mitchell, LB(2009).Vernakalant hydrochloride for The rapid conversion of atrial fibrillation after cardiac surgery: a randomized, doubleblind, placebo-controlled trial.Circ Arrhythm Electrophysiol,2,652-659.
15. Krahn, AD,Manfreda, J,Tate, RB(1995).The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study.Am J Med,98,476-484.
16. Lim, KT,Davis, MJ,Powell, A(2007).Ablate and pace strategy for atrial fibrillation: long-term outcome of AIRCRAFT trial.Europace,9,498-505.
17. Lip, GY,Nieuwlaat, R,Pisters, R(2010).Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation.Chest,137,263-272.
18. McLellan, AJ,Ling, LH,Azzopardi, S(2015).A minimal or maximal ablation strategy to achieve pulmonary vein isolation for paroxysmal atrial fibrillation: a prospective multi-centre randomized controlled trial (the Minimax study).Eur Heart J,36,1812-1821.
19. McMurray, JJ,Packer, M,Desai, AS(2014).Angiotensin-neprilysin inhibition versus enalapril in heart failure.N Engl J Med,371,993-1004.
20. Nery, PB,Belliveau, D,Nair, GM(2016).Relationship Between Pulmonary Vein Reconnection and Atrial Fibrillation Recurrence.JACC Clin Electrophysiol,2,474-483.
21. Okin, PM,Wachtell, K,Devereux, RB(2006).Regression of electrocardiographic left v entricular hypertrophy and decreased incidence of new onset atrial fibrillation in patients with hypertension.JAMA,296,1242-1248.
22. Opolski, G,Torbicki, A,Kosior, DA(2004).Investigators of the Polish how to treat chronic atrial fibrillation study. Rate control vs rhythm control in patients with nonvalvular persistent atrial fibrillation: the results of the Polish How to Treat Chronic Atrial Fibrillation (HOT CAFE) study.Chest,126,476-486.
23. Oyen, N,Ranthe, MF,Carstensen, L(2012).Familial aggregation of lone atrial fibrillation in young persons.J Am Coll Cardiol,60,917-921.
24. Pisters, R,Lane, DA,Nieuwlaat, R(2010).A novel userfriendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey.Chest,138,1093-1100.
25. Queiroga, A,Marshall, HJ,Clune, M(2003).Ablate and pace revisited: long term survival and predictors of permanent atrial fibrillation.Heart,89,1035-1038.
26. Roy, D,Pratt, CM,Torp-Pedersen, C(2008).Vernakalant hydrochloride for rapid conversion of atrial fibrillation: a phase 3, randomized, placebo controlled trial.Circulation,117,1518-1525.
27. Thrall, G,Lane, D,Carroll, D(2006).Quality of life in patients with atrial fibrillation: a systematic review.Am J Med,119,448.e1-448.e9.
28. Van Gelder, IC,Groenveld, HF,Crijns, HJ(2010).Lenient versus Strict rate control in patients with atrial fibrillation.N Engl J Med,362,1363-1373.
29. Van Gelder, IC,Hagens, VE,Bosker, HA(2002).Rate control versus electrical cardioversion for persistent atrial fibrillation study group. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation.N Engl J Med,347,1834-1840.
30. Verma, A,Sanders, P,Macle, L(2012).Substrate and Trigger Ablation for Reduction of Atrial Fibrillation Trial-Part II (STAR AF II): design and rationale.Am Heart J,164,1-6.e6.
31. Wolf, PA,Abbott, RD,Kannel, WB(1991).Atrial fibrillation as an independent risk factor for stroke: the Framingham Study.Stroke,22,983-988.
32. Wyse, DG,Waldo, AL,DiMarco, JP(2002).A comparison of rate control and rhythm control in patients with atrial fibrillation.N Engl J Med,347,1825-1833.
33. Ziff, OJ,Lane, DA,Samra, M(2015).Safety and efficacy of digoxin: systematic review and meta-analysis of observational and controlled trial data.BMJ,351,h4451.

1. 葉家豪,王俊潔(2019)。心律不整醫案報告。台北市中醫醫學雜誌，25(2)，31-39。