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2021 대한부정맥학회 심방세동 환자의 뇌졸중 예방 관리 지침

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2021 대한부정맥학회 심방세동 환자의 뇌졸중 예방 관리 지침

Correspondence to Jin-Bae Kim, M.D., Ph.D. Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, 23 kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea Tel: +82-2-958-8167, Fax: +82-2-958-8160, E-mail: [email protected]

5 Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea

4 Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea

Atrial fibrillation (AF) is a strong risk factor for ischemic stroke and systemic embolism. To prevent thromboembolic events in patients with AF, anticoagulation therapy is essential. The anticoagulant strategy is determined after stroke and bleeding risk assessments using the CHA 2 DS 2 -VASc and HAS-BLED scores, respectively; both consider clinical risk factors. Vitamin K antagonists (VKAs) are the sole anticoagulant option in AF patients with a prosthetic mechanical valve or moderate-severe mitral stenosis; in all other AF patients VKA or non-vitamin K antagonist oral anticoagulants are therapeutic options. However, antiplatelet therapy should not be used for stroke prevention in AF patients. Anticoagulation is not needed in AF patients with low stroke risk but strongly recommended in those with a with low bleeding risk. Left atrial appendage (LAA) occlusion offers an alternative in AF patients in whom long-term anticoagulation is contraindicated. Surgical occlusion or the exclusion of LAA can be considered for stroke prevention in AF patients undergoing cardiac surgery. In this article, we review existing data for stroke prevention and suggest optimal strategies to prevent stroke in AF patients.

오직 Watchman 기구만이 무작위 대조군 연구인 PROTECT AF (WATCHMAN Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation) 연구와 PREVAIL (Watchman LAA Closure Device in Patients With Atrial Fibrillation Versus Long Term Warfarin Therapy) 연구에서 비타민 K 길항제와 비교되었는데, 뇌졸중 위험도가 중등도 이상인 환자군에서 좌심방이 폐색술은 비타민 K 길항제와 비교하였을 때 열등하지 않음을 보여주었고, 장기간의 추적에서도, 출혈 위험을 감소시킬 수 있는 것으로 나타났다[ 82 – 85 ]. 항응고 치료의 금기증에 해당하는 환자들에서 좌심방이 폐색술은 뇌졸중 위험도도 낮추어 줄 수 있는 것으로 나타났다[ 83 , 86 ].

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심방세동 치료 가이드라인

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by- nc/3.0/ ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the general population. The Korean Heart Rhythm Society organized a Korean Atrial Fibrillation Management Guideline Committee and analyzed all available studies regarding the management of AF, including studies on Korean patients. This guideline is based on recent data of the Korean population and the recent guidelines of the European Society of Cardiology, European Association for Cardio-Thoracic Surgery, American Heart Association, and Asia Pacific Heart Rhythm Society. Expert consensus or guidelines for the optimal management of Korean patients with AF were achieved after a systematic review with intensive discussion. This article provides general principles for appropriate risk stratification and selection of anticoagulation therapy in Korean patients with AF. This guideline deals with optimal stroke prevention, screening, rate and rhythm control, risk factor management, and integrated management of AF.

심방세동 치료 가이드라인

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심방세동 치료 가이드라인

Guideline of atrial fibrillation management

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정보영 | 연세대학교 의과대학 세브란스병원 심장내과

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서론

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심장부정맥은 심장 리듬이 흐트러지는 병으로 뇌졸중, 급사 등 심각한 질환과 연관이 되어있다. 부정맥 중 특히 심방세동은 가장 흔하고 고령화로 전 세계적으로 유병률이 증가되고 있다. 국내에서도 최근 고령화로 인해 심방세동 환자가 더욱 뚜렷한 증가 추세를 보이고 있다.

심방세동은 특히 뇌졸중의 위험도를 약 4배 정도 올리지만 아직까지 국내 심방세동 환자의 항응고요법 사용률은 30% 미만으로 낮은 실정이다. 최근 보고된 삼차병원의 항응고요법 사용률은 83% 정도로 높은 수준을 유지함에 비하여 일차, 이차 기관의 항응고요법은 더욱 낮아서 심방세동 환자의 질환 관리에 대한 일차, 이차 의료기관 교육 및 협력의 중요성이 더욱 커지고 있다.

2018년 부정맥학회에서 발표한 ‘심방세동 치료 가이드라인’은 급속도로 증가하고 있는 심방세동 및 최근 도입된 비타민 K 비의존성 항응고제(non-vitamin K antagonist oral anti-coagulants, NOAC)를 고려하여 뇌졸중 예방의 중요성을 강조하고 심방세동 치료를 위하여 의료기관들의 협력이 요구되는 새로운 의료환경 변화에 대응하고자 개발되었다.

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