[AF-FORUM] 40E 进餐时的阵发性房颤 Dr. Stanley Nattel

[AF Symposium]

该阵发性房颤似乎是由于迷走神经造成。

I类药物（如氟卡尼、普罗帕酮）对这类心律失常有 
效。你也可以尝试丙吡胺，它具有抗副交感作用。

如果这些药物都无效而患者症状明显，肺静脉消融会 
有一定效果。

Stanley Nattel, MD

Paul-David心血管电生理主席

     医学教授

    蒙特利尔大学

Sergio Dubner医生
科委会主席
Edgardo Schapachnik医生
组委会主席
Ask：
我有一位患者有快室率的阵发性房颤，发作仅在进餐 
时出现（尤其是在吞咽时）。他现
在服用小剂量的β受体阻滞剂，但无法很好地控制可 
剂量由于出现了明显的低血压而无
法增大。他尝试使用可达龙，但出现了甲亢。地高辛 
没有作用。钙通道阻滞剂也无法耐受。患者因冠心病 
曾行PTCA/支架术，随后由于再狭窄进行了冠脉搭桥。 
如何处理这位患者的房
颤呢？

Azizul Haque医生
电生理专家
B M Birla心脏研究中心
印度

潘佳君译 王玲洁校


The PAF sounds as though it may be vagally precipitated.

Class I drugs (like flecainide and propafenone) may be particularly

effective in such cases. You may also try disopyramide because of its

anticholinergic properties.



If these medical options don't work, PV ablation might be quite

helpful if the patient is quite symptomatic and access to the

apprpriate facilities is available.



Stanley Nattel, MD

Paul-David Chair in Cardiovascular Electrophysiology

Professor of Medicine

University of Montreal

Director, Electrophysiology Research Program

Montreal Heart Institute Research Center

5000 Belanger St. E.

Montreal, Quebec

Canada H1T 1C8

T: 514-376-3330 ext 3990

F: 514-376-1355



--

Dr. Sergio Dubner

President of Scientific Committee



Dr. Edgardo Schapachnik

President of Steering Committee



 >

 > I have got a patient with episodes of PAF with high ventricular rate

 > ONLY during meals [specifically during deglutition]. He is presently

 > on low-dosage beta-blockers - but not controlled and dosage could not

 > be increased further because of significant hypotension. He was tried

 > with amiodarone, but he developed thyrotoxicosis. Digoxin was not of

 > help either. Calcium channel blockers was also not tolerated. Patient

 > is having coronary artery disease for which he underwent PTCA/

 > Stenting,subsequently CABG [due to restenosis ]. How to manage this

 > patient's AF?

 >

 > Dr.Md.Azizul Haque

 > Consultant Electrophysiologist

 > B M Birla Heart Research Centre

 > India





--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee