265.2 📚 國考版

265.2.0.1 必背 — AF Epidemiology

  • 38 million globally; lifetime risk ~ 25%
  • 5× higher stroke risk
  • Most common sustained arrhythmia

265.2.0.2 必背 — AF Classification (2023 ACC/AHA)

  • Stage 1: At risk
  • Stage 2: Pre-AF (atrial structural / flutter)
  • Stage 3: AF (paroxysmal, persistent, long-standing persistent, post-ablation)
  • Stage 4: Permanent

265.2.0.3 必背 — CHA2DS2-VASc Score

  • C (HF) + H (HTN) + A2 (≥75 yr) + D (DM) + S2 (stroke) + V (vascular) + A (65-74) + Sc (female)
  • Men ≥ 1, Women ≥ 2 = consider anticoagulation
  • 2024 ESC: same thresholds

265.2.0.4 必背 — HAS-BLED

  • HTN + Abnormal renal/liver + Stroke + Bleed + Labile INR + Elderly + Drug/Alcohol
  • Score ≥ 3 = high bleeding risk
  • Address modifiable factors

265.2.0.5 必背 — DOAC Choice

  • Apixaban: 5 mg bid (2.5 mg if 2 of: ≥80, ≀60 kg, Cr ≥1.5)
  • Rivaroxaban: 20 mg daily (15 if CrCl 30-50)
  • Edoxaban: 60 mg daily (30 if CrCl 15-50)
  • Dabigatran: 150 mg bid (110 if ≥80 or bleeding risk)

265.2.0.6 必背 — When to Use Warfarin

  • Mechanical heart valve (DOAC contraindicated — RE-ALIGN)
  • Moderate-severe mitral stenosis
  • Antiphospholipid syndrome (specific scenarios)
  • Severe renal failure
  • INR goal 2.0-3.0

265.2.0.7 必背 — Cardioversion + Anticoagulation

  • AF < 48 hr + low risk: cardioversion without anticoagulation
  • AF > 48 hr or unknown: 3-4 weeks therapeutic anticoagulation + 4 weeks post OR TEE for LAA thrombus + immediate cardioversion + 4 weeks post

265.2.0.8 必背 — Rate Control Drugs

  • β-blockers (first-line; metoprolol, bisoprolol, carvedilol)
  • Non-DHP CCB (verapamil, diltiazem)
  • Digoxin (HFrEF)
  • Combination if monotherapy insufficient
  • Goal: HR < 80 rest, < 110 exercise

265.2.0.9 必背 — Rhythm Control Drugs

  • Flecainide / Propafenone: no structural heart disease
  • Sotalol: structural OK, QT monitoring
  • Amiodarone: most effective but toxic; preferred in HF
  • Dofetilide: inpatient initiation
  • Dronedarone: less effective but better safety profile

265.2.0.10 必背 — Catheter Ablation Indications

  • Symptomatic paroxysmal AF (first-line increasingly)
  • Persistent AF
  • Failed antiarrhythmic drug
  • HFrEF + AF (CASTLE-HF)
  • Recently diagnosed (EAST-AFNET 4)
  • Pulmonary vein isolation (PVI) cornerstone

265.2.0.11 必背 — LAA Occlusion (Watchman, Amulet)

  • For patients with contraindication to long-term anticoagulation
  • Severe bleeding history, falls, drug interactions
  • Reduces stroke risk

265.2.0.12 必背 — Risk Factor Modification

  • Weight loss + exercise + alcohol cessation + OSA treatment (CPAP) + BP control

265.2.0.13 必背 — Key Trials

  • CASTLE-HF: ablation > medical therapy in HFrEF + AF
  • EAST-AFNET 4: early rhythm control > delayed in newly diagnosed
  • CABANA: ablation vs medical (specific subgroups ablation better)