POCKED GUIDELINES

for the Management of Patients with Atrial Fibrillation*

A Report of the American Colege of Cardiology/American Heart Association Task
Force on Practice Guidelines and the European Society of Cardiology Committee
for Practice Guidelines and Policy Conferences (Writing Committee to Develop
Guidelines for the Management of Patients with Atrial Fibrillation)

*
/

(
)
: :
Lars E. Ryden, Valentin Fuster,
MD, PhD, FACC, FESC MD, PhD, FACC
Representing: ESC Representing: ACC/AHA
Department of Cardiology Director, Zena and Michael A.Wiener
Karolinska Hospital Cardiovascular Institute
SE-171 76 Stockholm Mount Sinai Medical Center
SWEDEN One Gustave L.Levy Place, Box 1030
New-York, NY 10029-6500-USA

: (46) 8 5177 2171 : (1) 212 241 7911

: (46) 8 31 10 44 : (1) 212 423 9488
E-mail: lars.ryden@ks.se E-mail:valentin.fuster@msnyuhearth.org
lars.ryden@medks.ki.se

:
1. Richard W. Asinger, USA
2. David S. Cannom, USA
3. Harry J. Crijns, The Netherlands
4. Robert L.Frye, USA
5. Jonathan L. Halperin, USA
6. G. Neal Kay, USA
7. Werner W. Klein, Austria
8. Samuel Levy, France
9. Robert L. McNamara, USA
10. Eric N. Prystowsky, USA
11. L. Samuel Wann, USA
12. D. George Wyse, Canada

(ESC):
1. Keith McGregor, Sophia-Antipolis, France
2. Veronica Dean, Sophia-Antipolis, France
3. Dominique Poumeyrol-Jumeau, Sophia-Antipolis, France
4. Catherine Desprs, Sophia-Antipolis, France
5. Xue Li, Sophia-Antipolis, France
* /
/ESC: (European Heart Journal, 2001; 22: 1852-1923).
2

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 2. Vaughan Williams

Disopyramide II -
IA Procainamide (. Propranolol)
Chinidin
Lidocaine III Amiodarone
IB Mexiltine Bretylium
Dofetilide
Ibutilide
Sotalol
Flecainide IV -
IC Moricizine (.
Propafenone Verapamil Diltiazem)
Vaughan Williams EM. J Clin Pharmacol
1984:24:129-47, 1984 by Sage Publications Inc. ,
-
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17
 3.

7 *
( 5 )

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Dofetilide Per os I
Flecainide Per os I
Ibutilide I
Propafenone Per os I
Amiodarone Per os II
Chinidine Per os II b
-



Procainamide II b
Digoxin Per os III
Sotalol Per os III

*
.

18
 4.

7 *
( 5 )

*

-

Dofetilide Per os I
Amiodarone Per os II
Ibutilide II a
Flecainide Per os II b
Propafenone Per os II b
Chinidine Per os II b
-



Procainamide II b
Sotalol Per os III
Digoxin Per os III

* -
.

19
 5.

* **

Amiodarone Per os :
1,2 o 1,8 g , -
, 10 g,
200 o
400 mg ;
30 mg/kg .
:
600 o 800 mg ,
, 10 g,
200 o 400
mg .
/ 5 o 7 mg/kg 30 o 60 min,
Per os 1,2 o 1,8 g
per os
10 g,
200 o 400 mg .
Dofetilide Per os :
:
> 60 ml/min 500 mcg 2
40 o 60 ml/min 250 mcg 2
20 o 40 ml/min 125 mcg 2
< 20 ml/min
Flecainide Per os 200 o 300 mg
1,5 o 3,0 mg/kg 10 o
20 min
Ibutilide 1 mg 10 min;
1 mg,
Propafenone Per os 450 o 600 mg
1,5 o 2,0 mg/kg 10 o
20 min
Chinidine Per os 0,75 o 1,5 g 6 o 12
,

= ; i.v.= ; 2 =
* .
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.

20


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21
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Procainamide
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.
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22
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,
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)
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,
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,
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)
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, ,

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600 mg 1000
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QT-
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23
 8.



Vaughan Williams

.
Torsade de pointes ( I III)

( I)
/
QT ( I, I III)

.
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( I)
( I)

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26
 1. Digoxin -
II

.

,
.
2.
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1. Digoxin
II b
.
2. Chinidine, Procain-
amide, Disopyramide, Ibutilide Amiodarone
,
.
3. ,


,
.

III 1.

.
2.
.

27
 9.

Diltiazem 0,25 mg/kg i.v. 2 - 7 min 5 - 15 mg/h

2 min
Esmolol 0,5 mg/kg 5 min 0,05 0,2 mg/kg 1min
1 min
Metoprolol 2,5 - 5 mg i.v. 5 min NA
2 min;
o
Propranolol 0,15 mg/kg i.v. 5 min NA

Verapamil 0,075 - 0,15 3 - 5 min NA

mg/kg i.v.
2 min
Digoxin 0,25 mg i.v. 2h 0,125 - 0,25 mg
2 h,
1,5 mg

= .
*
.
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28

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29
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per os

* -
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2 h; o
1,5 mg
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,
;

-

Metoprolol NA 4-6h 25 o 100 mg

Propranolol NA 60 90 min 80 240 mg -
,

Verapamil NA 1 2 h 120 - 360 mg -
,
;

-

Amiodarone 800 mg 1 o 3 200 mg
1
600 mg
1
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30
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32
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60

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33
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60
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34
 12.




-

60 . Aspirin (325 mg ) I

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60 ., Aspirin (325 mg ) I
,
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*
60 . Per os I
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75 ., Per os I
(INR 2)
Per os I
(INR 2 o 3)
0,35 Per os I
(INR 2 o 3)
Per os I
(INR 2 o 3)
Per os I
(INR 2 o 3)
Per os I
( ) (INR 2,5 o 3,5 )
Per os I
(INR 2,5 o 3,5 )
Per os I
(INR 2,5 o 3,5 )
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= ; = ; = -
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= TEE = -
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35
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36
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a. ,

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.

37
 VII.

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.
2. , ,

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.
2.
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38


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WPW,
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.

39
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WPW,
, QRS-
E ( 120 ms).

IIb 1. Chinidine, Procain-

amide, Disopyramide, Ibutilide Amiodarone
,
.
a. ,
,
,

.

III -,
, Diltiazem, Verapamil
WPW - ,
.

I 1. -

, ,
.

40
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,

(Diltiazem Verapamil).
3. ,
,
(INR 2 o 3)
,

.
a.
,
,
.

I 1. Digoxin,
- .
2. ,

.
3.
( Aspirin)
(
).

IIb 1.
Chinidine, Procainamide Sotalol
,
.

41
 IIb 2. Heparin


. Heparin

,

() 1,5 o 2
()

10000 o 20000 U 12 h,
1,5
(6 h ).
a.

..
3.

I
, ,
(INR 2 3),
-
.

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.

,
Disopyramide Amioda-
rone.

42


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.
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III 1. Theophyllin -

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none Adenosine
, .

43
 :

44