265.4 📌 章末速蚘

265.4.0.0.1 AF Overview
  • Most common sustained arrhythmia; 38M globally; lifetime risk 25%; 5× stroke risk
265.4.0.0.2 Classification (2023 ACC/AHA Stages 1-4)
  • Stage 1 At risk → Stage 2 Pre-AF → Stage 3 AF (paroxysmal, persistent, long-standing) → Stage 4 Permanent
265.4.0.0.3 Risk Factors
  • HTN + Obesity + DM + OSA + Alcohol + Smoking + CAD + HF + Valvular + Hyperthyroid
265.4.0.0.4 Diagnosis
  • ECG: irregularly irregular + no P waves; wearables (Apple Watch, KardiaMobile)
265.4.0.0.5 4 Management Pillars
  1. Rate / Rhythm control
  2. Anticoagulation for stroke prevention
  3. Risk factor modification
  4. Comorbid disease management
265.4.0.0.6 Stroke Risk
  • CHA2DS2-VASc: Men ≥ 1, Women ≥ 2 = consider anticoagulation
265.4.0.0.7 Bleed Risk
  • HAS-BLED: ≥ 3 = high; address modifiable
265.4.0.0.8 Anticoagulation
  • DOAC preferred (apixaban, rivaroxaban, edoxaban, dabigatran)
  • Warfarin: mechanical valve, moderate-severe MS
  • Reversal: idarucizumab (dabigatran), andexanet (factor Xa inhibitors)
  • LAA occlusion (Watchman, Amulet) for contraindication
265.4.0.0.9 Rate Control
  • β-blocker, non-DHP CCB, digoxin (HFrEF)
  • Goal: HR < 80 rest, < 110 exercise
265.4.0.0.10 Rhythm Control
  • Cardioversion + antiarrhythmics + catheter ablation (PVI)
  • Catheter ablation increasingly first-line symptomatic + HFrEF + early diagnosis
  • Drugs: flecainide/propafenone (no structural), sotalol, amiodarone (HF + most effective), dofetilide, dronedarone
265.4.0.0.11 Key Trials
  • CASTLE-HF: ablation > medical in HFrEF + AF
  • EAST-AFNET 4: early rhythm control > delayed
  • CABANA: ablation vs medical (subgroups favor ablation)
  • LEGACY: weight loss reduces AF burden
265.4.0.0.12 Risk Factor Modification
  • Weight loss + OSA treatment (CPAP) + alcohol reduction + exercise + BP control
265.4.0.0.13 盧醫垫 hint
  • AF stroke prevention: CHA2DS2-VASc + DOAC (preferred over warfarin) for most
  • Mechanical valve + AF: warfarin (DOAC contraindicated)
  • HFrEF + AF: consider early ablation (CASTLE-HF)
  • Recently diagnosed AF: consider early rhythm control (EAST-AFNET 4)
  • OSA + AF: CPAP reduces recurrence
  • Weight loss: 10% reduces AF burden (LEGACY)
  • AF + bleeding risk + can’t anticoagulate: LAA occlusion (Watchman, Amulet)