Guideline AF2012

atrial fibrillation (AF)
aftrial fibrillation (AF)

2555
6,000

National Library of Thailand Cataloging in Publication Data
.

Atrial fibrillation .-- :
, 2555.
87

1. . 2. --. I. ,
. I. .

616.128
ISBN 978-616-91386-2-4

0 2214 4660 0 2612 4509
E-mail : smprt2005@yahoo.com

45

AF

1 2

( )



AF AF

(.. )


AF

( )

( )

20 2555
10
AF
18
AF
20
AF
26
AF
42
AF
45
53
AF
61
AF
64
AF
66
80

AF

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
AF
G
AF
G

G AF
G

G

G AF
G

G AF

10
AF

1 systematic review randomized

controlled clinical trials well designed randomized

controlled clinical trial
2 systematic review controlled clinical

trials well designed controlled clinical trial

( cohort study, case-control study)
3 descriptive studies controlled clinical

trial
4 (consensus)
11

++

+/-

- -

Atrial Fibrillation (AF) Atrial Flutter (AFL)
Atrial fibrillation (AF) supraventricular tachyarrhythmia

P wave 350
Atrial flutter (AFL) supraventricular tachyarrhythmia

P wave 250-350
:

AF
12
sinus node AF preexcitation syndrome

AF

(irregularly irregular)

(pulse deficit)

AF
1) P wave lead II
V1
2) P wave 350
3) RR interval
AFL
1) P wave lead II V1
2) P wave 250 350
3) Isoelectric line P wave
lead II, III, aVF

4) RR interval
2:1, 3:1

13

1. Complete blood count serum creatinine
AF
AF
2. Thyroid function test AF
hyperthyroidism

3. Chest X-ray
4. Echocardiogram
antithrombotics Holster
monitor, events recorder, implantable loop recorder
AF AF

Atrial fibrillation 5
1. First diagnosed atrial fibrillation atrial fibrillation

2. Paroxysmal atrial fibrillation atrial fibrillation
sinus rhythm 24
7
3. Persistent atrial fibrillation atrial fibrillation
7
(cardioversion)
4. Long standing persistent atrial fibrillation atrial fibrillation
1

14
5. Permanent atrial fibrillation atrial fibrillation

atrial frbirllation

atrial flutter

atrial fibrillation 1-2
0.5 40-50
5-15 80
10-30
lone atrial fibrillation

30 0.65
.. 2534 0.36 30

AF

1. (cardiovascular disease)

2. (non-cardiovascular disease)

3. (Idiopathic)
15

1. (focal activation)
thyroid
hormone, catecholamine
pulmonary veins
2. (multiple reentrant circuits)

(structural and electrical remodeling)

3.

AF

1.

2. AF
3.

4. Radiofrequency ablation
AF
5. AF
6.
AF Left atrial appendage occlision

16

atrial fibrillation
(stroke) 2-7

AF
(heart failure) AF
AF

17
AF

()
()
RAS (Renin-aldosterone system)
Statins Omega-3-polyunsaturated fatty acid (PUFA)
RAS ACEIs ARBs
AF

(multiple
cardiovascular risk factors) AF
electrical cardioversion
beta blocker LV
systolic dysfunction AF 27
Statins AF
Statins

aldosterone antagonist, omega-3-polyunsaturated fatty
acid

18
( antiarrhymic drug)
AF

2
ACEI ARB
+

AF

2
ACEI ARB
+

AF

AF

3
ACEI ARB
+

AF (electrical

cardioversion)

(antiarrhythmic drug)

3
ACEI ARB
-

electrical cardioversion

3
Statins
+

3
Statins
-

3
Polyunsaturated fatty acid aldosterone
-
antagonist AF
19
AF

(Rhythm control) AF
sinus rhythm
(RF ablation) (rate control)
AV node

AF paroxysmal persistent permanent AF1
( 1)
1
AF

AF

Paroxysmal
Persistent
Permanent

20
paroxysmal AF
2-3

1.
2. 3.
4. 2
3-8

AF
(tachycardia-mediated cardiomyopathy)
110
9
nondihydropyridine calcium
antagonist diltiazem verapamil
amiodarone digoxin
(negative inotrope) 2
21
1 AF

Diltiazem 0.25 . / .
5-15 . / . 30-90 . 2-3
Verapamil 5-10 .
-
40-80 . 2-3
Digoxin 0.25 . 2 . 1 . -
0.125-0.25 .
Propanolol -
-
10-40 . 3-4
Metropolol -
-
25-100 . 2
Atenolol -
-
25-100 .
Bisoprolol -
-
2.5-10 .
Carvedilol -
-
3.125-25 . 2
Amiodarone 5 . / . 1.
50 . / . 100-200 .
2 AF

p
() AF
0.32
PIAF (2000)
Persistent AF
252
0.08
AFFIRM (2002)
4060 Paroxysmal

Persistent AF

> 65

RACE (2002)
Persistent AF 0.11
522

flutter

STAFF (2003)
Persistent AF, 0.99
200

LVEF < 45%

0.71
HOT CAF
Persistent AF < 2
205

(2004)

0.59
AF-CHF (2008)
1376 Persistent AF,
LVEF < 35%
22

nondihydropyridine
10 digoxin
paroxysmal AF AV node 11
AV node
AF pre-excitation Wolf-Parkinson-White
syndrome
amiodarone

12

MAZE procedure AV nodal ablation
complete AV block
13

23
AF

1.
+ +
1

paroxysmal AF

3
2.
+

3
3.
+

2
4.
+

2
5. AF
+

6.
+ +
2
AF
24
AF

2
1. AF
+ +

pre-excitation

2
2. digoxin amiodarone
+ +

2
3.
+ +

pre-excitation
+
2
4. 110

+
3
5. digoxin

3
+
6. digoxin

+ / -
3
7.

AV node

3
-
8. Amiodarone

3
-
9. digoxin

paroxysmal AF
3
- -
10.

- -
3
11. digoxin
pre-excitation

25

AF

AF
AF
AF

DC cardioversion
AF AF
AF WPW syndrome
AF
24

ECG monitor
ventricular
arrhythmia, SA arrest, AV block
(Pill-in-the pocket therapy) structural heart

disease
1 1
26
1

AF ( < 48 )

IV Amiodarone
- IV oral Flecainide

- IV oral Propafenone

- IV Ibutilide

- IV Amiodarone
27
1

Flecainide - 2 mg/kg IV
-

10

- 200-300 mg
- QRS

QT

-

Atrial

flutter (1:1)
Propafenone - 2 mg/kg IV

-

10

- 450-600 mg

- QRS

-

Atrial

flutter (1:1)

Ibutilide - 1 mg IV 1 mg IV 10 - QT

10 torsades de pointes
10

- monitor EKG

QT TU

1 mg IV 4

10 -

Amiodarone - 5 mg/kg 50 mg / -
-
1
-
-
28

1
+ +

IV flecainide

propafenone AF
1
+ +

IV amiodarone
2
+
AF

flecainide

propafenone

(pill-in-the-Pocket)

+ / -
1
AF

IV ibutilide

electrolyte & QT

monitor 4

proarrhythmia
1, 2, 3
-
diqoxin, verapamil, sotalol, metoprolol,

-blockers
(
b
)
29
G Flecainide 2 mg/kg IV 10 AF
( < 24 ..) 67-92% 6
1 atrial flutter persistent AF
200-400 mg (Pill-in-the-pocket approach)
recent-onset AF

G Propafenone 2 mg/kg IV 10
41-91% 2-3
persistent AF atrial flutter

-blocking effect
b
450-600 mg
G Amiodarone 5 mg/kg IV 1
50 mg/ flecainide propafenone 24
80-90%
40-60%

G Ibutilide 1 mg IV 10 10
1 mg IV 10
30-90 50-71% AF
atrial flutter
polymorphic ventricular tachycardia nonsustained
DC cardioversion electrolyte, QT interval
ECG monitor 4
30
digoxin AF
verapamil, -blockers,
sotalol
b

Pill-in-the-pocket
propafenone 45% 3
18%
propafenone flecainide
propafenone 450-600 mg flecainide 200-300 mg
paroxysmal AF
structural heart disease

AF

AF
AF
AF 1
31

1.
AF
AF
2.

3.
AF AF
4.

5. proarrhythmia

6.

32
2 AF

- ACEI / ARB / Statin
-
remodeling
- ACEI / ARB /Statin
b
- -blockers

remodeling

- -blockers
b

HT CAD HF

LVH significant LVH
(LVPW > 1.4 cm) ** Amiodarone

- Flecainide
- Amiodarone - Amiodarone*/
- Propafenone

Dronedarone
- Amiodarone*/

- Sotalol
Dronedarone
- Sotalol
* amiodarone dronedarone dronedarone
hypothyroidism
hyperthyroidism amiodarone
dronedarone
** LVH Echo- cardiogram
Dronedarone
33
ECG

AV node
Flecainide 100-200 mg b.i.d. - Ccr < 50 - QRS -

mg/ml CAD > 25%

LVEF

Propafenone 150-300 mg t.i.d. - CAD, LVEF - QRS -

- > 25%

-

Sotalol 80-160 mg b.i.d. - LVH - QT > 500 ms
b

-blockers

QT

prolongation,

+

K , Ccr < 50mg/ml

34
Amiodarone 600 mg o.d. -

4 , QT,

400 o.d.

4 Vit K

200 antagonists
Diqoxin

mg o.d.
Dronedarone 400 mg b.i.d. -
NYHA class
III-IV unstable
class II
-
QT
-
CYP3A4
-
Ccr < 30mg/ml
- Serum Cr
0.1-0.2 mg/dl

- permanent AF
-
LVH
- LFT
1
ECG

AV node
- QT > 500 ms

10-12

/

AF

- QT > 500 ms -
-
< 50/ 10-12
- PR interval > /
AF
280 ms
35

AF

1

1
- Amiodarone
+
1
- Dronedarone
+
1
- Flecainide
+
1
- Propafenone
+
1, 3
- Sotalol
+

Amiodarone
+

3

NYHA
+

Class III, IV class II

amiodarone

2

3
-blockers
adrenergic AF

b
+
2

dronedarone
+
3
non-permanent AF CVS risk factors

b-blockers (
+
2
) AF

dronedarone
- -

NYHA Class III, IV class II

3
permanent AF

SA AV
- -
node pacemaker
36
2
G
b - blockers AF
AF
394 metoprolol AF 47.7%
59.9% (p = 0.005) b-blockers
AF
b-blockers

G Flecainide 2
paroxysmal AF cardioversion AF

Left bundle branch block
flecainide ECG monitor QRS
duration 25%
proarrhythmia flecainide
AV node b -blockers flecainide
propafenone AF Atrial flutter
AV node
G Propafenone
flecainide b-blockade
b-blockers
G Quinidine metaanalysis
proarrhythmia torsade
de pointes
37
G Amiodarone propafenone
sotalol

AF structural heart disease
torsade de pointes amiodarone
class III
class proarrhythmia amiodarone
QT interval
G Sotalol amiodarone Sotalol
Amiodarone AF Efficacy Trial (SAFE-T) sotalol
Amiodarone QT interval
QT > 500 ms
proarrhythmia , LVH ,
ventricular arrhythmia , K+ ,
Mg2+
G Dronedarone amiodarone Iodine
12-24
400 mg bid loading dose amiodarone
adipose tissue
AF DIONYSOS
AF amiodarone
ANDROMEDA
dronedarone
dronedarone
NYHA functional class III, IV unstable class II
38
ATHENA 4628 paroxysmal persistent

AF/Atrial flutter stroke > 70
dronedarone
dronedarone

stroke dronedarone

dronedarone serum creatinine 0.1-0.2
mg% tubular excretion of creatinine

post marketing
survey 2 2 dronedarone hepatic
necrosis
dronedarone
US FDA MEA
dronedarone LFT
6 9 12

PALLAS dronedarone placebo
permanent AF
3400 dronedarone
2 dronedarone
permanent AF AF 6
NSR

39

AF
b -blockers
amiodarone

G Lone AF AF structural heart disease
b
-blockers
flecainide, propafenone, sotalol
dronedarone vagally mediated AF disopyramide
anticholinergic effects
G AF underlying heart disease ,
flecainide
propafenone proarrhythmia
sotalol
sotalol

amiodarone

< 200 mg amiodarone randomized
control trial dronedarone ATHENA
metaanalysis amiodarone

dronedarone
amiodarone AF
permanent
40
AF dronedarone
AF
G AF sotalol, flecainide
propafenone
1.4 proarrhythmia
amiodarone dronedarone

G AF amiodarone
dronedarone NYHA
class I II
4
dronedarone
dronedarone
41
AF

AF

2
1. AV node (AV node ablation)
(Rate control) AF

2. (AF ablation) (rhythm
control)
AV node

1. AV node

AV node
complete AV block

(Bi-ventricular pacemaker)
AV node

paroxysmal AF persistent permanent AF

AF

42
2.
AF
1. AF

2.

3. paroxysmal AF

AF

1. Pulmonary vein ablation AF
(APC)

AF
G Focal PV ablation
G Segmental PV ablation

G Circumferential PV ablation

2. Non pulmonary vein ablation AF

PV ablation
43
Non PV ablation
paroxysmal AF
Non PV ablation
2.1 Linear ablation

2.2 Complex fractionated atrial electrograms (CFAE)
AF
2.3 Ganglionic plexi ablation

44
AF

AF thromboembolic events (TE)
TE 1% lone AF
20% rheumatic mitral stenosis TE

TE
atrial flutter AF atrial

flutter atrial fibrillation
AF atrial flutter
AF

(HASBLED score)
1.
2.
3.
4.
5.
6. INR
7. 65
8.

9.

AF atrial fibrillation
paroxysmal, persistent permanent AF AF
45

AF
Lone AF AF 60
echocardiogram
lone AF lone AF
Non-valvular AF AF significant valvular
disease
TE CHA2DS2-VASc score
G Major risk factors 1. stroke, TIA systemic embolism
2. 75
G Clinically relevant non-major risk factors
1. Congestive heart failure moderate to severe left ventricular
systolic dysfunction
2.
3.
4.
5. 65-74
6. myocardial infarction, peripheral artery
disease, aortic plaque

AF
++
1. AF
TE AF 65
( 1)
2. AF rheumatic valvular disease
TE
46
(anticoagulant) INR 2-3 INR 2.5-3.5

( 1)
3. non-valvular AF
TE
TE major risk factors
clinically relevant non-major risk factors
INR
2-3 ( 1)
4. TE clinically
relevant non-major risk factors
INR 2-3 ( 1)
aspirin 75-325 . ( 2)
aspirin

+
1. TE TE
aspirin 75-325 .
( 2)

+/-
1.
aspirin 75-100 . clopidogrel 75
.
( 2)

47

AF sinus rhythm
(atrial stunning)
TE
AF

TE

++
1. AF 48

INR 2-3
3 4
( 2)
2. AF
AF
iv unfractionated heparin
APTT ratio 1.5-2.0 low
molecular weight heparin
INR 2-3
4 TE
( 2)
3. TE AF
48 iv unfractionated heparin
APTT ratio 1.5-2.0 low molecular weight
heparin (
48
2)
4.
INR 2-3 3 transesophageal echocardiogram
iv unfractionated
heparin
APTT ratio 1.5-2.0 subcutaneous low molecular weight heparin
4 (
2)

+
1. AF 48
TE
( 3)

AF
( CHADs2 > 2 ) major risk factors
clinically relevant non-major risk factors

(antiplatelet)
aspirin
primary secondary prevention AF
aspirin stroke AF
warfarin (INR 2-3) aspirin

(stent) 2

49
+
1. AF

(
4)
2. acute coronary syndrome AF

aspirin, clopidogrel anticoagulant
3-6 clopidogrel
aspirin ( peptic ulcer) 1 (
4)
3. AF

4
clopidogrel aspirin ( peptic ulcer) (
4)
4. AF

3-6 clopidogrel
aspirin 1 (
4)

50
perioperative AF
++
1. perioperative AF
AF ( 2)

perioperative period
warfarin

hypertrophic
cardiomyopathy
+
1. HCM AF
( 3)

direct thrombin inhibitor dabigatran

warfarin
warfarin
TE AF
150 mg Factor Xa
inhibitors rivaroxaban, apixaban
warfarin TE AF
warfarin

51
warfarin

pulmonary emboli

TE AF Dabigatran
warfarin warfarin

52

(cardioversion)
2
(thrombo-embolism)
48
cardioversion (
)

1.

2. (rhythm
control)

ventricular proarrhythmia, sinus
node arrest atrioventricular block

1. Flecainide
G 2 / 10
AF 24
53
G 1
G 6 67-92
G AF
200-400
G atrial flutter persistent AF
G

2. Propafenone
G 2 ./. 10-20
AF
G 2-6
G 41-91 30 2
G AF
450-600 .
G atrial flutter persistent AF
G

flecainide propafenone
(pill-in-the-pocket)
G flecainide propafenone

G sinus AV node bundle branch block
G Brugada syndrome QTc interval
G AF
non-
54
dihydropyridine
30 AV node
atrial flutter
3. Amiodarone
G 5 ./. 1
1200-1800 ./ 10
200-400 .
G

G 24
( 40-60 80-90)
G (structural heart
disease)
G

4. Ibutilide
G 1 . 10
10 AF
G
30
G 90 50
G 10 polymorphic ventricular
tachycardia

G
4 QTc interval 60

55
G
QTc interval
G atrial flutter AF
5. digoxin, verapamil metoprolol
AF

AF
+ +
1


1
AF
+ +

amiodarone

2
AF
+


pill-in-the-pocket

1
AF
+
QTc

interval ibutilide

digoxin, verapamil
-
1
metoprolol
56

1.
2.
preexcitation
3. AF 1-2
AF amiodarone,
AF

G
G AF
G AF
G
G
G long-short sequence
G (varia-
tions in atrial conduction)

1.
1-2
2. midazolam, propofol
fentanyl
3. flumazenil
naloxone
4.
57

.

.

8-10
. AF
pacing threshold
5.
(synchronized cardioversion)

digoxin
150-200 AF
P 2

(biphasic truncated waveform)

6.
3
QTc interval
1-2
58

3

+ +

+

preexcitation

2
+

2
amiodarone, flecainide propafenone
+

3
diltiazem verapamil
+

+
3

3
digoxin
-
59

AF ( < 48 )

(structural heart disease)

Amiodarone
Flecainide

Propafenone

Ibutilide
60
AF

(Echocardiogram)
Atrial Fibrillation (AF)

(Transthoracic
echocardiography TTE)
1. AF
1-2 1 ( +,
4)
2. AF

1 (+,
2)
1
AF
1.

2.
AF
3. (Left ventricular size and function)
4.

61
(Transesophageal
echocardiography TEE) AF
TEE left
atrial appendage

TEE
3-5

(Smoky appearance Spontaneous Echo
Contrast)
3-5
62
TEE
TEE
( +, 1)6
1

AF 48

TEE

Heparin

3

TEE 2

(Cardio version)

4

63
AF

AF
Sinus rhythm
1,2 AF 2
1. AF

2. AF (Lone AF)
AF
Maze
3 Pulmonary veins isolation, Isthmus
lines Left atrial appendage
Ablation Maze
3,4 Ablation energy
(Radio frequency) (Cryoablation) Maze

Sinus Rhythm 90-95%1,2,3,4 Maze

3,4,7
AF 1,2,4 Sinus
rhythm (EF)
(Exercise tolerance) (Long
term survival) 11,2
AF Maze
Mitral Sinus rhythm 92% 1 5
Lone AF Paroxysmal
Persistent AF4,6,7 AF
64
AF

1 Atrial Fibrillation
+
1. AF
2. AF

+/-
1. AF

2. Lone AF

3. Paroxysmal AF

-

60 Cardiothoracic ratio
Calcification Atrial wall
65
AF

1.
AF
substrate, trigger AF

AF

Rhythm control
Direct cardioversion (DCC)
hemodynamic hemodynamic
amiodarone
sinus rhythm
(rate control)
beta-blocker ( acute decompensated heart
failure)
beta-blocker digoxin
beta-blocker digoxin
calcium blocker (CCB)
functional capacity

rhythm control radiofrequency ablation

66
2.
AF
AF 2-10

beta-blocker
digoxin, nondihydropyridine CCB

AF paroxysmal
(pill in the pocket)
1-2 half life

AF
radiofrequency ablation
80% paroxysmal AF AF

3.
mitral AF
left atrium aortic AF
AF
INR 2-3
67
AF

mitral AF AF

4. (acute coronary
syndrome)
AF 2-21% AF
PCI ACEI, ARB,
beta-blocker AF

DCC
hemodynamic, ongoing ischemia
amiodarone, beta-blocker
digoxin, nondihydropyridine calcium blocker

5.
AF

AF

6. (elderly)
AF 10% 80
18% 85
68
AF
1. AF

2. AF

3.

4. AF

5.

6. AF DCC
AF sick sinus syndrome
cardioversion AF
AF
EKG

aspirin
7.

warfarin
6.4%

69
low molecular weight heparin UFH

1
AF hemodynamic compromise DCC

DCC amiodarone

atenolol
digoxin
overdose
8. atrial fibrillaion
AF
30% 40% 50%

beta-blocker, amiodarone, sotalol
AF atrial pacing
AF Stroke 57%
AF

AF hemodynamic
DCC DCC
hemodynamic amiodarone
ibutilide
70

beta-blocker, nondihydropyridine CCB digoxin
1C agent
AF 48

9.
AF 10-25%

beta-blocker, nondihydropyridine calcium blocker
DCC
DCC
AF
10. Wolff-Parkinson-White Syndrome
AF ( atrial flutter, atrial tachycardia )
accessory bypass tract

300-400 / ventricular
fibrillation 0.15-0.39%
accessory pathway 90%
1% sudden cardiac
arrest AF

accessory pathway AF

71
11. Hypertrophic Cardiomyopathy

hypertrophic cardiomyopathy AF 20-25%
2% AF
hypertrophic
cardiomyopathy DCC medical cardioversion
AF amiodarone
dronedarone myectomy
Maze operation

12.
AF AF

theophylline, beta agonist AF
multifocal atrial tachycardia DCC medical
cardioversion
DCC hemodynamic
medical cardioversion amiodarone

nondihydropyridine calcium antagonist
selective beta1 antagonist bisoprolol
nonselective beta-blocker, sotalol, propafeone, adenosine
72
AF

1. (heart failure)
3
+ +
1.1

AF

+ +
1.2 amiodarone
3

Functional class III, IV

4

+
1.3 Amiodarone
2

+
1.4 Functional
3

Class I, II Dronedarone

non-permanent AF

+ / -
1.5
2

persistent AF

+ / -
1.6
2

AF

73
2. (Athlete)
2.1 Sodium channel blockers

pill in the pocket
1-2 half life
(propafenone 5-17 flecainide 12-27 )
2.2 atrial flutter
atrial flutter
Sodium channel blockers

2.3
AF
2.4 AF

2.5
AF

3. (Valvular Heart Disease)
3.1 OAC (oral anticoagulant)

3.2 AF

74

3
+

3
+

3
+ / -

3
- -

3
- -

4
+ +

3
+


3
+
3.3 AF

4.

(acute coronary syndrome)
3
+ +
4.1

AF

3
+ +
4.2 amiodarone

3
+
4.3 beta blocker

3
+
4.4 verapamil, diltiazem

3
-
4.5 digoxin

2
- -
4.6 flecainide, propafenone

5. (diabetes mellitus)
3
+ +
5.1

75

6. (elderly)

2
6.1 65
+ +

AF

7. (pregnancy)
3
+ +
7.1 AF

3
+ +
7.2 thromboembolism

2
+ +
7.3 OAC

2
+ +
7.4 Low molecular weight heparin

UFH

aPTT 1.5
3
+
7.5 beta blocker, non-dihydropyridine

calcium channel blocker

beta blocker

3
7.6 flecainide, ibutilide
-

3
-
7.7 digoxin beta

blocker, non-dihydropyridine calcium channel blocker

76

8. (postoperative atrial

fibrillation)
1
+ +
8.1 beta blocker AF

1

2
+ +
8.2

AF

1
+
8.3 AF

amiodarone
1
+
8.4 antithrombotic/anticoagulant

AF 48
2
+
8.5 antithrombotic/anticoagulant

4 AF

1
-
8.6 Sotalol AF

(proarrhythmia)
1
-
8.7 biatrial pacing AF

2
-
8.8 Corticosteriod AF

77

9. (hyperthyroidism)
3
+ +
9.1 antithrombotic

3
+
9.2 beta blocker

3
+
9.3 non-dihydropyridine calcium

channel blocker beta blocker

3
+
9.4

10. Wolff-Parkinson-White Syndrome (WPW)
1
+ +
10.1 WPW

AF

sudden cardiac arrest
2
+
10.2 WPW

ion overt accessory pathway

AF

11. Hypertrophic Cardiomyopathy
2
+ +
11.1

AF persistent AF
3
+
11.2 OAC (Oral anticoagulant)
3
+
11.3 amiodarone (

disopyramide + beta blocker)

78

3
11.4
-

AF

3
11.5 AF
-

septal myectomy

12. (Pulmonary Disease)

3
12.1
+ +

acute exacerbation AF
3
12.2
+ +

AF

3
12.3 non-dihydropyridine calcium channel
+

blocker

Obstructive pulmonary disease AF

3
12.4 selective beta1 beta blocker
+ / -

( bisoprolol)

3
12.5 theophylline, beta agonist
- -

bronchospastic lung disease AF
3
- -
12.6 nonselective beta blocker,
sotalol, propafenone adenosine
obstructive lung disease AF
79
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1379-1383.
. (2550). atrial fibrillation
(AF). -,
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87

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Guideline AF2012

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atrial fibrillation (AF)

aftrial fibrillation (AF)

atrial fibrillation (AF)

atrial fibrillation (AF)

atrial fibrillation (AF)

atrial fibrillation (AF)

atrial fibrillation (AF)

atrial fibrillation (AF)

atrial fibrillation (AF)

atrial fibrillation (AF)

sinus node AF preexcitation syndrome

lead II, III, aVF

atrial fibrillation (AF)

atrial fibrillation (AF)

5. Permanent atrial fibrillation atrial fibrillation

atrial fibrillation (AF)

atrial fibrillation (AF)

atrial fibrillation (AF)

atrial fibrillation (AF)

atrial fibrillation (AF)

atrial fibrillation (AF)

atrial fibrillation (AF)

atrial fibrillation (AF)

atrial fibrillation (AF)

(Pill-in-the pocket therapy) structural heart

atrial fibrillation (AF)

atrial fibrillation (AF)

atrial fibrillation (AF)

atrial fibrillation (AF)

atrial fibrillation (AF)

structural heart disease

atrial fibrillation (AF)

atrial fibrillation (AF)

Flecainide 100-200 mg b.i.d. - Ccr < 50 - QRS -

atrial fibrillation (AF)

Amiodarone 600 mg o.d. -

atrial fibrillation (AF)

atrial fibrillation (AF)

atrial fibrillation (AF)

ATHENA 4628 paroxysmal persistent

mg% tubular excretion of creatinine

structural heart disease

atrial fibrillation (AF)

atrial fibrillation (AF)

paroxysmal AF persistent permanent AF

atrial fibrillation (AF)

atrial fibrillation (AF)

atrial fibrillation (AF)

atrial flutter AF atrial

atrial fibrillation (AF)

(anticoagulant) INR 2-3 INR 2.5-3.5

atrial fibrillation (AF)

atrial fibrillation (AF)

direct thrombin inhibitor dabigatran

atrial fibrillation (AF)

atrial fibrillation (AF)

atrial fibrillation (AF)

atrial fibrillation (AF)

tions in atrial conduction)

(biphasic truncated waveform)

atrial fibrillation (AF)

atrial fibrillation (AF)

atrial fibrillation (AF)

atrial fibrillation (AF)