[AF-FORUM] 140S房颤快心率的控制及未来Dr. Pereira

[AF Symposium]

50%的快速房颤可以自行转律。如果你说此病例不需要 
立即复律，那意味着此患者没有血液动力学反应，至 
少没有显著的反应。如果是那样，最好不要仓促复 
律。有一些中间变量例如年龄和既往病理，这同周末 
大量饮酒后发生阵发性房颤的年轻患者不同。与老年 
人相比，这些年轻患者没有已知的病理结构改变。我 
们正在谈论的是有快心室反应的阵发性房颤。而大多 
数病例，我会以口服治疗开始（便于控制且较安 
全）。没有血液动力学障碍的年轻患者，多数情况下 
住院治疗是没有必要的。他们需要安泰乐治疗，我会 
选择胺碘酮，一般都会恢复窦律。这是个关键药物， 
应用足够剂量并达到适当控制，均有比较满意的疗 
效。在使用药物前，我一般都会应用一定剂量的肝素 
（依诺肝素40mg），因为我并没有忘记在转复窦律的 
时，血栓的发生同心房的震荡有关。

我希望我的回答会有所帮助。

Luciano Pereira



赵宏伟翻译 王玲洁校




Subject:Re: [AF-FORUM] 140S A-Fib Tach RATE control in ER and the  
next day. Dr. Pereira




50% of acute fibrillations revert spontaneously. If you say that the  
case does not require immediate CV, it means that the patient does  
not present hemodynamic repercussion, at least, not a significant  
one. If that is the case, the best thing to do is not to rush. There  
are intervening variables such as age and previous pathologies. It is  
not the same to be a young person having a PAF on a weekend after  
drinking too much, than to be an elderly person, even when there is  
no “known structural pathology”. I understand we are talking about  
a PAF with high ventricular response. In most of the cases, I would  
start with oral medication (much easier to manage and safer). In  
young patients, without hemodynamic repercussion, many times  
hospitalization is not even necessary. And should they need  
parenteral medication, I would choose amiodarone, with which I can  
revert to sinus rhythm almost always. It is a noble drug, which when  
used with the adequate dose and with the appropriate control it  
provides many satisfactions. I always give a dose of fractioned  
heparin (enoxaparin 40 mg) before starting infusion, because we  
should not forget that when reverting to sinus rhythm thrombi could  
be released from a stunned atrium.

I hope I was helpful.

Luciano Pereira



Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee