Andrade Jason G, Macle Laurent, Nattel Stanley, Verma Atul, Cairns John
University of British Columbia, Vancouver, British Columbia, Canada; Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
Can J Cardiol. 2017 Aug;33(8):965-976. doi: 10.1016/j.cjca.2017.06.002. Epub 2017 Jun 9.
In this article we compare and contrast the current recommendations, and highlight the important differences, in the American College of Cardiology/American Heart Association/Heart Rhythm Society, European Society of Cardiology, and Canadian Cardiovascular Society atrial fibrillation (AF) guidelines. Although many of the recommendations of the various societies are similar, there are important differences in the methodologies underlying their development and the specific content. Specifically, key differences can be observed in: (1) the definition of nonvalvular AF, which subsequently affects anticoagulation choices and candidacy for non-vitamin K antagonist oral anticoagulants; (2) the symptom score used to guide management decisions and longitudinal patient profiling; (3) the stroke risk stratification algorithm used to determine indications for oral anticoagulant therapy; (4) the role of acetylsalicylic acid in stroke prevention in AF; (5) the antithrombotic regimens used in the context of coronary artery disease, acute coronary syndromes, and percutaneous coronary intervention; (6) the rate control target and medications recommended to achieve the target; and (7) the role of "first-line" catheter ablation, open surgical ablation, and left atrial appendage exclusion.
在本文中，我们比较并对比了美国心脏病学会/美国心脏协会/心律学会、欧洲心脏病学会以及加拿大心血管学会的心房颤动（AF）指南中的当前建议，并强调了其中的重要差异。尽管各学会的许多建议相似，但在其制定背后的方法以及具体内容方面存在重要差异。具体而言，在以下方面可观察到关键差异：（1）非瓣膜性房颤的定义，这随后会影响抗凝选择以及非维生素K拮抗剂口服抗凝药的适用情况；（2）用于指导管理决策和患者纵向分析的症状评分；（3）用于确定口服抗凝治疗指征的卒中风险分层算法；（4）乙酰水杨酸在房颤卒中预防中的作用；（5）在冠状动脉疾病、急性冠状动脉综合征和经皮冠状动脉介入治疗背景下使用的抗栓方案；（6）心率控制目标以及为实现该目标推荐使用的药物；（7）“一线”导管消融、开放式外科消融以及左心耳封堵的作用。
