单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,非抗心律失常药物的抗,房颤作用,非抗心律失常药物的抗房颤作用,心房颤动特点,临床上最常见的需药物与非药物治疗的心律失常,并非是一种良性心律失常,慢性房颤多发生于器质性心脏病患者，少数患者无心脏病证据,发生率随年龄增加而增高,缺血性脑卒中的主要原因之一,快速心室率未能控制者，可发生心动过速性心肌病,心房颤动特点临床上最常见的需药物与非药物治疗的心律失常,心房颤动的流行病学,累积发生率男性为,2.2%,、女性为,1.7%,70,左右的房颤发生在器质性心脏病,大约,30,的房颤无任何可发现的病因,病死的最主要原因是缺血性脑卒中，其发生率随年龄增加明显升高,心房颤动的流行病学 累积发生率男性为2.2%、女性为 1.7,Atrial fibrillation accounts for 1/3 of all patient discharges with arrhythmia as principal diagnosis.,2%VF,Data source:Baily D.J Am Coll Cardiol.1992;19(3):41A.,34%Atrial Fibrillation,18%Unspecified,6%PSVT,6%PVCs,4%AFL,9%SSS,8%Conduction Disease,3%SCD,10%VT,Arrhythmia as principal diagnosis,Atrial fibrillation accounts f,Mortality,Framigham Study,Benjamin EJ et al,Framigham Heart Study,Circulation 98;98:946-952,55-74 years,75 94 y,MortalityFramigham StudyBenjam,心房颤动的病理生理和电生理机制,房颤常发生于三种不同的临床情况,无心脏病证据患者，,称原发性房颤,虽无心脏病证据，但有诱发房颤发生的非心脏性疾病,(,甲亢等,),，为继发性房颤,发生于器质性心脏病者的,继发性房颤,心房颤动的病理生理和电生理机制 房颤常发生于三种不同的临床情,心房颤动的病理生理和电生理机制,心房颤动的病理组织学,心房扩张和不均匀分布的纤维化,(,窦房结,),见于器质性心脏病,非特异的散在纤维化,继发于全身性疾病,心房肌细胞离子通道的功能异常或未识别的非病理性结构异常,发生于健康人的阵发性房颤,(,孤立性房颤,),心房颤动的病理生理和电生理机制心房颤动的病理组织学,心房颤动的病理生理和电生理机制,心房颤动的电生理机制,异位局灶自律性增强学说,(Scherf,等，,1953),多个子波折返激动学说,(Moe,等，,1959),触发因素：,房早、房扑、房速、,AVNRT,、,AVRT,、交感或迷走神经活性改变等,心房颤动的病理生理和电生理机制心房颤动的电生理机制,心房颤动的病理生理和电生理机制,局灶性房颤的起源部位,肺静脉,(,90%,以上,尤其为左、右上肺静脉,),其他部位包括：,界嵴、上、下腔静脉、冠状静脉窦、房室交界区、房间隔、,Marshall,韧带、心房游离壁,起源于肺静脉、腔静脉、冠状静脉窦的房颤可能与肌袖,(,muscular sleeve,),有关,?,心房颤动的病理生理和电生理机制局灶性房颤的起源部位,心房颤动的分类,阵发性房颤：,发作持续,7d,，大多可自行转复，并可反复发作,持续性房颤：,发作,48,小时以上未能自行转复而需要药物或非药物干预,永久性房颤,：,发作持续几天（,7d,）或几年,心房颤动的分类,心房颤动的治疗原则,控制心室率,预防栓塞性事件,转复心房颤动为窦性心律,直流电转复心律,药物复律及维持窦性心律,非药物预防房颤复发,心脏起搏预防心房颤动,(,?,),心房颤动的治疗原则控制心室率,Treatment strategies for AF,Atrial fibrillation,Antiarrhythmic,drugs,Preventive Pacing,Alate and bpace,Hybrid therapy,Atrial Defibrillator,MAZE-surgery,Catheter ablation,ACE-I、ARB、,Statin、Diuretic,Treatment strategies for AFAtr,Effectiveness of rhythm control in AF with OAP and AAD after linear RACA,Hybrid therapy utilizing,cathter RA maze procedures,with,OAP,and,AAD,can be performed safely and can reestablish rhythm control in selected patients with refractory persistent or permanent AF,OAP:,overdrive atrial pacing,AAD:,antiarrhythmic durg,Effectiveness of rhythm contro,非抗心律失常药物的抗房ppt课件,非抗心律失常药物的抗房ppt课件,非抗心律失常药物的抗房ppt课件,具有抗心律失常作用,的,非抗心律失常药物,Angiotensin converting enzyme inhibitors(ACE-I),Angiotensin receptor Blocker(ARB),Statin,Diuretics,具有抗心律失常作用的非抗心律失常药物Angiotensin,非抗心律失常药物抗心律失常作用,的可能机理,ACE-I,和,ARB,抗心律失常作用的可能机理包括：,Decrease of wall stress and lowering of blood pressure,Modulation of refractoriness,Interference with ion currents,Modification of sympathetic tone and stabilization of electrolyte concentration,Interaction between ARB and potassium channel blocker on transmembrane action potentials and currents,ARB modified the cardiac delayed retifier hKv1.5.HEKG and Ks currents,非抗心律失常药物抗心律失常作用的可能机理ACE-I和AR,Angiotensinogen,Angiotensin I,Angiotensin II,AT1,AT2,Renin,ACE,Non-ACE,AT,1,Blockers,Vasoconstriction,Neurohumoral retention,Hydro-saline retention,Cell growth,Vasodilation,Growth Inhibition,Apoptosis,Effects of AT,1,receptor blockers on angiotensin II and,bradikinin synthesis and inactivation,AngiotensinogenAngiotensin I,Genetic Factors and Modifiers and Enrivironmental Stress,Determinant,Long-term CatecholaminesStructural Free Radicals ModulatorsAnd acuteTriggers,ACE,Angiotensin II,Aldosterone Cytokines Nitric Oxide,Structural and Electrical Remodeling,Gene Structure,Fibrosis Ion channerls,Extracellular Matrix Aotonomics,Fiber orientation Gap junctions,Calcium handling,RateActivationsequence,Enhancement of ArrhythmiaHeterogencity Facilitators,Arrhythmia,Arrhythmia,Triggers,Substrate,Phenotypic,Expression,New approaches to antiarrhythmic therapy.Eur Heart J,2001,Genetic Factors and Modifiers,Enalapril decrease the incidence of atrial fibrillation in patients with left ventricular dysfunction,Insight From the,S,tudies,O,f,L,eft,V,entricular,D,ysfunction,(SOLVD),Trial,Background,AF occurring in the course of experimental HF induced by rapid ventricular pacing is accompanied by atrial electrical and structural remodeling,including atrial dilation,contractile dysfunction,and fibrosis.ACEI have been demanstrated a role for ACEI in the prevention of this atrial structure remodeling,Enalapril decrease the inciden,SOLVD Trial,Methods and Results,391 Pts,374 Pts,17 Pts,186 Pts/,ACEI,55 Pts,10 Pts,45 Pts,P0001,188 Pts/,plac.,SOLVD TrialMethods and Resul,Insight From the,S,tudies,O,f,L,eft,V,entricular,D,ysfunction,(SOLVD),Trial,Conclusion,Treatment with the ACE-I e