심방세동의 비약물적 치료 (Nonpharmacologic Treatment for Atrial Fibrillation)

서지정보

· 발행기관 : 대한내과학회
· 수록지 정보 : 대한내과학회지 / 81권 / 4호 / 428 ~ 433페이지
· 저자명 : 온영근

초록

고주파 전극도자절제술은 선택된 심방세동 환자군에서는 약물치료에 비해 우월한 것으로 알려져 있고 일부 연구에서 사망률을 감소시키는 것으로 보고되고 있다. 현재 다양한 환자군에서 연구가 진행되고 있으며 심방세동의 기전에 대한 자세한 이해 및 여러 기술적인 개발이 이러한 치료법을 향상시키는데 기여하리라 생각한다. 또한 항혈전 약물사용에 문제가 있는 심방세동 환자에서 뇌졸중의 예방을 위해 좌심방 부속기의 폐쇄를 고려할 수 있겠다.

영어초록

Atrial fibrillation (AF) is the most common cardiac arrhythmia and its prevalence is expected to increase with increasing age. The risk of stroke also increases substantially with age. There are three strategies for the management of AF, that is, rate control, rhythm control and anticoagulation for prevention of embolism. Antiarrhythmic drugs are usually used for rhythm control as first line therapy but there are some limitations in using antiarrhythmic drugs for AF. Catheter ablation of AF should be considered as second line therapy. The primary indication for catheter ablation is the presence of symptomatic AF refractory or intolerant to antiarrhythmic medication. Warfarin is more effective effective in preventing stroke than aspirin and combination aspirin- clopidogrel. Despite its proven efficacy, warfarin is often not well tolerated by patients, has a very narrow therapeutic range, and has a high risk for bleeding complications. Echocardiography and autopsy studies showed that the left atrial appendage (LAA) was the source of thrombi in more than 90% of patients with non-valvular AF. Percutaneous catheter-based devices have been developed to close and thereby effectively exclude the LAA from the systemic circulation. (Korean J Med 2011;81:428-433)

참고자료

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