medicina60巻2号

2023年02月発行

特集 慢性疾患診療のお悩みポイントまとめました—高血圧からヘルスメンテナンスまで 心房細動

心房細動でアブレーションを意識する場面はどんなときですか？

著者： 眞柴貴久¹ 大森崇史²³⁴

所属機関： ¹飯塚病院循環器内科 ²福岡ハートネット病院総合内科 ³福岡ハートネット病院循環器内科 ⁴福岡ハートネット病院地域連携支援部

ページ範囲：P.331 - P.335

Point
◎心房細動患者は国内で実に100万人に上ると言われている．プライマリ・ケアの現場でも遭遇するcommonな疾患であり，死亡率，脳卒中，心不全，認知症のリスクを増加させる．
◎カテーテルアブレーションは抗不整脈薬よりも洞調律維持率が高く，QOLの改善，運動耐容能の改善が見込まれ，特に発作性心房細動で有効である．
◎症状の有無，年齢，心房細動のタイプによって洞調律化維持の妥当性が決定される．カテーテルアブレーションの急性期リスクを説明したうえでshared decision making（共同意思決定）を行う必要がある．

参考文献

1）Ohsawa M, et al：Rapid increase in estimated number of persons with atrial fibrillation in Japan；An analysis from national surveys on cardiovascular diseases in 1980, 1990 and 2000. J Epidemiol 15：194-196, 2005

2）Gerhard H, et al：2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery（EACTS）；The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology（ESC）Developed with the special contribution of the European Heart Rhythm Association（EHRA）of the ESC. Eur Heart J 42：373-498, 2020

3）Haïssaguerre M：Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 339：659-666, 1998

4）Nassir F, et al：Catheter ablation for atrial fibrillation with heart failure. N Engl J Med 378：417-427, 2018

5）Douglas L, et al：Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation. JAMA 321：1261-1274, 2019

6）Turagam MK, et al：Assessment of catheter ablation or antiarrhythmic drugs for first-line therapy of atrial fibrillation；A meta-analysis of randomized clinical trials. JAMA Cardiol 6：697-705, 2021

7）日本循環器学会，日本不整脈心電学会：不整脈非薬物治療ガイドライン（2018年改訂版），2021　https://www.j-circ.or.jp/cms/wp-content/uploads/2018/07/JCS2018_kurita_nogami.pdf（2022年10月閲覧）

8）Friberg L, et al：Catheter ablation for atrial fibrillation is associated with lower incidence of stroke and death；Data from Swedish health registries. Eur Heart J 37：2478-2487, 2016

9）Boriani G, et al：Asymptomatic atrial fibrillation；Clinical correlates, management, and outcomes in the EORP-AF Pilot General Registry. Am J Med 128：509-518, 2015

10）Mohanty S, et al：Catheter ablation of asymptomatic longstanding persistent atrial fibrillation；Impact on quality of life, exercise performance, arrhythmia perception, and arrhythmia-free survival. J Cardiovasc Electrophysiol 25：1057-1064, 2014

11）Yagishita A, et al：Improvement in the quality of life and exercise performance in relation to the plasma B-type natriuretic peptide level after catheter ablation in patients with asymptomatic persistent atrial fibrillation. Circ J 81：444-449, 2017

12）Anter E, et al：Atrial fibrillation and heart failure；Treatment considerations for a dual epidemic. Circulation 119：2516-2525, 2009

13）Pappone C, et al：Atrial fibrillation progression and management；A 5-year prospective follow-up study. Heart Rhythm 5：1501-1507, 2008

14）Pathak RK, et al：Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation；The ARREST-AF cohort study. J Am Coll Cardiol 64：2222-2231, 2014

15）Mohanty S, et al：Impact of metabolic syndrome on procedural outcomes in patients with atrial fibrillation undergoing catheter ablation. J Am Coll Cardiol 59：1295-1301, 2012

16）Calkins H, et al：2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 20：e1-160, 2018

17）Chew D, Piccini JP：Long-term oral anticoagulant after catheter ablation for atrial fibrillation. Europace 23：1157-1165, 2021