45.3 🩺 內科專科考前版

45.3.0.1 📌 䞀頁重點

  • 22E: AF rhythm control trial (EAST-AFNET)、early ablation strategy、wearable devices (Apple Watch)
  • WPW + AF: avoid AVN block
  • Brugada genetic screening
  • Taiwan: catheter ablation 健保

45.3.0.2 💊 進階治療

45.3.0.2.1 AF
  • Early rhythm control (EAST-AFNET) within 12 months
  • Ablation > antiarrhythmic for selected
  • Anticoagulation: DOAC > warfarin
  • LAA closure for high-risk AC contraindication
45.3.0.2.2 SVT
  • RFA cure rate > 95%
  • AVNRT, AVRT WPW
  • Long-term recurrence low
45.3.0.2.3 VT
  • ICD for primary / secondary prevention
  • Catheter ablation for monomorphic VT
  • Genetic counseling for channelopathy
45.3.0.2.4 Atrial Tach
  • Focal RFA

45.3.0.3 🌟 Pearls (8)

  1. Wearable detection: Apple Watch + Kardia 改變 AF detection
  2. EAST-AFNET 4 trial: early rhythm control benefit
  3. Catheter ablation > antiarrhythmic for AF in many
  4. DOAC ≥ warfarin for non-valvular AF
  5. WPW + AF procainamide (avoid AVN block)
  6. Brugada fever 癌病
  7. Long QT KCNQ1/KCNH2/SCN5A mutations
  8. Inappropriate sinus tachycardia: ivabradine

45.3.0.4 📍 台灣 Context

  • 健保 catheter ablation
  • DOAC 健保 (apixaban, rivaroxaban, dabigatran, edoxaban)
  • Brugada in Asia 高 prevalence
  • AF burden 䞊升 with aging

45.3.0.5 🎓 內專重點

  1. 5 殺手
  2. CHA2DS2-VASc + HAS-BLED
  3. WPW + AF
  4. Long QT / Brugada / CPVT
  5. AF rhythm control 22E
  6. ICD indications
45.3.0.5.1 跚章節
  • Ch 23 Syncope
  • Ch 252-258 Arrhythmia

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