Xử trí rung nhĩ ở bệnh nhân suy tim

Hội nghị Tim mạch học toàn quốc - Ninh Bình - 11/2015 XỬ TRÍ RUNG NHĨ Ở BỆNH NHÂN SUY TIM TS NGUYỄN THỊ THU HOÀI VIỆN TIM MẠCH QUỐC GIA VIỆT NAM RUNG NHĨ VÀ SUY TIM Fibrillation in HeartFailure Failure AtrialAtrial Fibrillation in Heart FUNCTIONAL CLASS Functional class Functional class II SOLVD, 1992 SOLVD, 1992 SOLVD, 1991 SOLVD, 1991 V-HeFT, 1991 V-HeFT, 1991 CHF-STAT, 1991 CHF-STAT, 1991 Stevenson, 1996 Stevenson, 1996 GESICA, 1994 GESICA, 1994 CONSENSUS, 1987 CONSENSUS, 1987 Patients (%) II-III II-III III-IV III-IV IV IV 20 20 40 60 60 4040 60 Patients (%) 80 80 Patients (%) European Survey of Primary Care Physicians European Survey of Primary Care Physicians European Survey of Primary Care Physicians • 15 countries • 1,363 physicians • 15 countries 11,062 pt • 1,363• physicians • 1999-2000 A fibrillation • 11,062 pt • 1999-2000 Symptoms Symptoms Stevenson W Moderate ® severe Cleland J: Lancet, 2002 41% Stevenson W Moderate ® severe 22% A fibrillation 22% 100 100 100 The interrelated pathophysiology of AF and HF CÂU HỎI LÂM SÀNG Có chuyển nhịp hay không? Có sử dụng thuốc chống loại nhịp tim hay không? Kiểm soát tần số thất? Xử trí suy tim ứ huyết? Sử dụng thuốc chống đông nào? Does AF increase mortality in HF? AF and all-cause mortality in LV dysfunction All-Cause Mortality SOLVD Trials 1.0 Sinus rhythm (n=6,098) 0.8 P[...]... sinus rhythm may be stabilized with beta-blockers  BB drugs can reduce the occurrence of AF in patients with CHF Adequate HF (with RAAS blockers…)  the chance to maintain sinus rhythm and should be optimized before cardioversion  Amiodarone is safe and effective, if loaded before electrical cardioversion  In severe HF and hemodynamic deterioration associated with AF, intravenous amiodarone and immediate