p.22 抽出テキスト
Rate control target = resting heart rate <110 b.p.m. (lenient control), with stricter control with continuing symptoms (Class IIa) Beta-blocker or digoxin (Class I) Patient with paroxysmal AF LVEF ≤40% Beta-blocker, digoxin, diltiazem or verapamil (Class I) Combination rate control therapy (Class IIa) Combination rate control therapy (Class IIa) Amiodarone (Class I) Dronedarone, flecainide or propafenone (Class I) Catheter ablation (Class I) Amiodarone or dronedarone (Class I) Sotalol (Class IIb) HFrEF (LVEF ≤40%) Stable HFmrEF (LVEF 41–49%), coronary heart disease, valvular heart disease Absence or minimal heart disease Sotalol (Class IIb) Recurrence of AF symptoms Antiarrhythmic drug therapy Y N Shared decision-making on rhythm control (Class I) If failed antiarrhythmic drug therapy If failed catheter ablation Re-do catheter ablation (Class IIa) Surgical/hybrid ablation (Class IIb) Antiarrhythmic drug therapy (see above) Catheter ablationa (Class I) Shared decision-making (Class I) Follow AF-CARE for [C] comorbidity and risk factor management & [A] avoid stroke and thromboembolism Figure 5 [R] Pathway for patients with paroxysmal AF. AF, atrial fibrillation; AF-CARE, atrial fibrillation—[C] Comorbidity and risk factor management, [A] Avoid stroke and thromboembolism, [R] Reduce symptoms by rate and rhythm control, [E] Evaluation and dynamic reassessment; b.p.m., beats per minute; HFmrEF, heart failure with mildly reduced ejection fraction; HFrEF, Heart failure with reduced ejection fraction; LVEF, left ventricular ejection fraction. aIn patients with HFrEF: Class I if high probability of tachycardia-induced cardiomyopathy; and Class IIa in selected patients to improve prognosis. ESC Guidelines 3335 Downloaded from academic.oup.com/eurheartj/article/45/36/3314/7738779 by guest on 07 October 2026