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雑誌文献

総合診療30巻2号

2020年02月発行

文献概要

特集 いつ手術・インターベンションに送るの?|今でしょ! 今じゃないでしょ! 今のジョーシキ!【循環器・消化器・神経疾患編】 【循環器疾患】

不整脈

著者: 井上耕一1

所属機関: 1桜橋渡辺病院循環器内科

ページ範囲:P.165 - P.170

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心房細動・発作性心房細動へのアブレーション
Q1 有症候性の発作性心房細動ですが、80歳を超えると、もうアブレーションの適応はありませんよね?
心房細動アブレーションの適応は、年齢、症状、進行度を総合的に勘案して決められます(図1)。高齢者での侵襲的治療は慎重であるべきですが、年齢だけで、「適応なし」となることはありません。特に、「症状によりADLが低下している場合」などは、積極的に考えましょう。

参考文献

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2)Packer DL, et al, CABANA Investigators : Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation ; the CABANA randomized clinical trial. JAMA 15, 2019. PMID 30874766
3)Karamichalakis N, et al : Managing atrial fibrillation in the very elderly patient ; challenges and solutions. Vasc Health Risk Manag 11 : 555-562, 2015. PMID 26604772
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6)日本循環器学会/日本不整脈心電学会合同ガイドライン:不整脈非薬物治療ガイドライン(2018年改訂版) www.j-circ.or.jp/guideline/pdf/JCS2018_kurita_nogami.pdf
7)Ling Z, et al : Radiofrequency ablation versus antiarrhythmic medication for treatment of ventricular premature beats from the right ventricular outflow tract ; prospective randomized study. Circ Arrhythm Electrophysiol 7(2) : 237-243, 2014. PMID 24523413
8)Baman TS, et al : Relationship between burden of premature ventricular complexes and left ventricular function. Heart Rhythm 7(7) : 865-869, 2010. PMID 20348027
9)Yokokawa M, et al : Relation of symptoms and symptom duration to premature ventricular complex-induced cardiomyopathy. Heart Rhythm 9(1) : 92-95, 2012. PMID 21855522
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11)Shen WK, et al : 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope ; a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 136(5) : e60-e122, 2017. PMID 28280231
12)Gladstone DJ, et al, EMBRACE Investigators and Coordinators : Atrial fibrillation in patients with cryptogenic stroke. N Engl J Med 370(26) : 2467-2477, 2014. PMID 24963566
13)Sanna T, et al, CRYSTAL AF Investigators : Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med 370(26) : 2478-2486, 2014. PMID 24963567
14)Giada F, et al : Current and emerging indications for implantable cardiac monitors. Electrophysiol 35(9) : 1169-1178. PMID 22530875
15)Volpi A , et al : Incidence and prognosis of early primary ventricular fibrillation in acute myocardial infarction--results of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI-2) database. Am J Cardiol 82(3) : 265-271 1998. PMID 9708651
16)Piccini JP, et al : Sustained ventricular tachycardia and ventricular fibrillation complicating non-ST-segment-elevation acute coronary syndromes. Circulation 126(1) : 41-49, 2012. PMID 22645292
17)Moss AJ, et al, Multicenter Automatic Defibrillator Implantation Trial Ⅱ Investigators : Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 346(12) : 877-883, 2002. PMID 11907286
18)Bardy GH, et al, Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) Investigators : Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 352(3) : 225-237, 2005. PMID 15659722

掲載誌情報

出版社:株式会社医学書院

電子版ISSN:2188-806X

印刷版ISSN:2188-8051

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