p.24 抽出テキスト

LVEF >40%

Patient with permanent AF

Y

Evaluation and dynamic

reassessment

Initiate beta-blocker,

digoxin, diltiazem

or verapamil

(Class I)

Continue beta-blocker,

digoxin, diltiazem

or verapamil

(Class I) Combination beta-blocker

with digoxin, or diltiazem/

verapamil with digoxin; avoiding bradycardia

(Class IIa)a

N

Rate control target = resting heart rate <110 b.p.m. (lenient control), with stricter control with continuing symptoms

(Class IIa)

Continue review and follow-up as per

AF-CARE approach

LVEF ≤40%

Continue beta-blocker

or digoxin (Class I) Combination beta-blocker with digoxin,

avoiding bradycardia

(Class IIa)

Y

Evaluation and dynamic

reassessment

Initiate beta-blocker

or digoxin (Class I)

Rate control target = resting

heart rate  <110 b.p.m. (lenient control), with stricter control with continuing symptoms

(Class IIa)

N Severely symptomatic and

HF hospitalization

Atrioventricular node

ablation and CRT

(Class IIa)

Y

Intensify rate control therapy under

observation

Evaluation for atrioventricular node ablation in combination with pacemaker

(Class IIa)

N

Follow AF-CARE for [C] comorbidity and risk factor management & [A] avoid stroke and thromboembolism

Rate control target = resting

heart rate  <110 b.p.m. (lenient control), with stricter control with continuing symptoms

(Class IIa)

Figure 7 [R] Pathway for patients with permanent 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; CRT, cardiac resynchronization therapy; HF, heart failure; LVEF, left ventricular ejection fraction. Permanent AF is a shared decision made between the patient and physician that no further attempts at restoration of sinus rhythm are planned. aNote that the combination of betablockers with diltiazem or verapamil should only be used under specialist advice, and monitored with an ambulatory ECG to check for bradycardia.

ESC Guidelines                                                                                                                                                                                          3337

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