老人性不整脈

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こうじさくもと
5 years ago
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1 資料 : QOL CHADS NOAC はじめに common disease 高齢者の不整脈の頻度, AF AVB RBBB LBBB Cardiovascular Health Study,

2 137 表 1 Outpatient Atarashi Cardiovascular Health Study Monolio No F M Ectopic beats Supraventricular. %. %. % Ventricular AF.. Sinus bradycardia.. AVB st nd... rd... RBBB LBBB. Atarashi et al. Japan yrs leads ECG Cardiovascular Heath Study USA yrs h Holter ECG 高齢者の不整脈発生の成因 P P SSS, 高齢者の不整脈の症状

3 138 図 1 不整脈の診断高齢者の不整脈の治療 QOL, QOL CHADS CHADS

4 139 NOAC, NOAC CHADS NOAC CHADS NOAC VVI DDD DDD 図 2

5 140 図 3 CHADS 図 4

6 141 図 5 図 6 Cyclic AMP A PDE おわりに

7 142 QOL 著者の COI 開示文献. Manolio TA, Fluberg CD, Rautaharju PM, et al. Cardiac arrhythmias on 24-h ambulatory Electrocardiography in older woman and men. The Cardiovascular Health Study. J Am Coll Cardiol ; 23 : Gage BF, Waterman AD, Shannon W, et al. Validation of clinical classification schemes for prediction stroke: results from the national registry of atrial fibrillation. JAMA 2001 ; 285 :

8 143 Cardiac Arrhythmias in the Elderly Takuya MORI It is widely recognized that the elderly show an increased prevalence of cardiac arrhythmias. In this population, abnormalities in the conduction system can be the result of degenerative and fibrotic changes that occur with aging. Underlying disorders such as hypertension, diabetes mellitus, ischemic heart disease, congestive heart failure, and electrolyte imbalance may lead to the onset and exacerbation of arrhythmia. Cardiac arrhythmias, particularly in the elderly, are disorders of sinus node function (sinus bradycardia and sick sinus syndrome), abnormalities in the conduction system (AV block and bundle branch block), and supraventricular arrhythmia (supraventricular premature contraction and atrial fibrillation). The variety of symptoms, variation in individual constitution, and associated dementia reported can be attributed to the difficulties in eliciting clinical signs. In drug treatment, age-related changes of the pharmacokinetics and pharmacodynamics of antiarrhythmics have been evaluated extensively. Treatment of arrhythmia in elderly patients is complicated, and a clinical dilemma may often be encountered because of multiple comorbidities, decreased physiologic reserve, and polypharmacy. The incidence of atrial fibrillation (AF) increases with age. Cardiac embolic stroke is a major complication of AF. The CHADS2 score could be used to evaluate the risk of stroke in patients with AF. Oral anticoagulation, using either vitamin K anticoagulants or novel oral anticoagulants (NOACs), has consistently demonstrated a reduction in the risk of ischemic stroke. In terms of non-pharmacologic treatment, the indications for permanent pacemaker implantation, cardiac ablation, and cardioverter defibrillators in the elderly should be established without any age limit. However, careful consideration of invasive techniques is necessary. Because of the lower cardiac reserve, physiological pacing is useful in elderly patients. Dept. of Internal Medicine, Suzuka-Chuo General Hospital, Mie, Japan

C/NC : committed/noncommitted

C/NC : committed/noncommitted 110 time post-icd implant 1) The Cardiac Arrhythmia Suppression Trial (CAST) Investigators Preliminary report : Effect of encainaide and flecainide on mortality in a