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2018 대한부정맥학회 심방세동 환자의 통합적 관리 지침
박준범 ( Junbeom Park ),정보영 ( Boyoung Joung ),김준 ( Jun Kim ),김진배 ( Jin-bae Kim ),박형욱 ( Hyung Wook Park ),박예민 ( Yae Min Park ),엄재선 ( Jae-sun Uhm ),안진희 ( Jinhee Ahn ),이대인 ( Dae In Lee ),김준수 ( June Soo Kim 대한내과학회 2018 대한내과학회지 Vol.93 No.4
Atrial fibrillation (AF) is the most common form of sustained arrhythmia in elderly patients. However, AF is often detected during health screening, or accidentally during testing for other diseases; some patients lack clinical symptoms. Nevertheless, AF increases the incidence of ischemic stroke and other thrombotic events, and compromises cardiovascular prognosis in terms of heart failure, dementia, and hospitalization. Therefore, initial AF management should be performed at the point of primary care, not only in specialized medical centers. We wish to propose a five-step management protocol for AF. We review the evidence supporting integrated management by primary care physicians new to AF, and by specialized physicians who often diagnose and manage AF. Further, we also outline a structured goal-based follow-up protocol; this is an important part of integrated management. (Korean J Med 2018;93:336-343)
2021 대한부정맥학회 심방세동의 선별 검사 및 무증상 심방세동의 관리 지침
이정명 ( Jung Myung Lee ),김태훈 ( Tae-hoon Kim ),박진규 ( Jin-kyu Park ),정보영 ( Boyoung Joung ),최의근 ( Eue-keun Choi ) 대한내과학회 2021 대한내과학회지 Vol.96 No.2
Atrial fibrillation (AF) is a strong risk factor for embolic stroke. In patients with AF, optimal anticoagulation therapy, administered according to the stroke risk scoring system, can effectively reduce the stroke risk. However, AF episodes are frequently asymptomatic, with a significant number of them detected after a stroke event. Therefore, the early detection of subclinical AF and the subsequent administration of optimal oral anticoagulation therapy is expected to reduce the risk of stroke. However, this strategy requires more effective screening for the detection of AF in the asymptomatic stage, which accounts for the recent research interest in silent/subclinical AF. Today, the widespread use of cardiac implantable electronic devices and wearable rhythm monitors has enabled the detection of atrial high-rate episodes/subclinical AF in a substantial number of patients. The risk of stroke appears to be related to the duration of this phenomenon. Subclinical AF increases the risk of stroke, but generally not as much as clinical AF, but whether long-term anticoagulation therapy is required in patients with subclinical AF is unclear. Here we review existing data on the epidemiology, clinical significance, and suggest guidelines on management of subclinical AF and the optimal screening strategies aimed at its detection. (Korean J Med 2021;96:76-84)
2021 대한부정맥학회 심방세동 환자의 뇌졸중 예방 관리 지침
이기홍 ( Ki Hong Lee ),김진배 ( Jin-bae Kim ),신승용 ( Seung Yong Shin ),정보영 ( Boyoung Joung ) 대한내과학회 2021 대한내과학회지 Vol.96 No.4
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<sub>2</sub>DS<sub>2</sub>-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. (Korean J Med 2021;96:296-311)
2021 대한부정맥학회 심방세동 환자의 새로운 접근법 및 통합적 관리 지침
박준범 ( Junbeom Park ),차명진 ( Myung-jin Cha ),백용수 ( Yong Soo Baek ),조민수 ( Min Soo Cho ),정보영 ( Boyoung Joung ) 대한내과학회 2021 대한내과학회지 Vol.96 No.5
The prevalence of atrial fibrillation (AF) is gradually increasing with the aging of the population, and there is also increasing interest in AF with the development of various single-lead electrocardiography measurement methods for diagnosis. Further, the current diagnosis and treatment policies for AF do not reflect its progression and complexity. In addition, the various factors related to AF diagnosis and treatment are not simple due to the diversification of tools, advances in treatment methods, and complex mechanism of AF. Therefore, there are many challenges to developing a simple AF classification system. To overcome these, there have been a number of attempts to systematically characterize AF according to treatment and prognosis rather than using a uniform classification. Further, as mentioned in the previous AF guidelines, further research is being conducted on an integrated patient-physician approach to AF. Such an approach would be the basis for consistent treatment based on the guidelines, and would help to improve patient outcomes. Further, for the integrated management of AF patients, some changes should be made to the current approach to develop a multidisciplinary approach, including changes to the behavior of team members, patients, their family members, and physicians. The Korean Heart Rhythm will introduce an integrated approach to the classification and structure of AF management, and provide guidelines for its application in clinical practice. (Korean J Med 2021;96:382-389)
심방세동과 말기 콩팥병이 동반된 환자에서 와파린과 항혈소판 요법의 안전성과 효과 비교
한동희 ( Donghee Han ),엄재선 ( Jae-sun Uhm ),박정탁 ( Jung Tak Park ),김태훈 ( Tae-hoon Kim ),정보영 ( Boyoung Joung ),유태현 ( Tae-hyun Yoo ),박희남 ( Hui-nam Pak ),강신욱 ( Shin-wook Kang ),이문형 ( Moon-hyoung Lee ) 대한내과학회 2019 대한내과학회지 Vol.94 No.2
목적: 심방세동과 말기 콩팥병이 동반된 환자에서 항응고제의 치료는 아직 명확히 정립되지 않았다. 본 연구에서는 이러한 환자에서 와파린과 항혈전제의 효과 및 안정성을 비교해 보았다. 방법: 본 연구에서는 2004년 1월부터 2014년 7월까지 단일기관에서 심방세동과 말기 콩팥병을 진단받은 총 256명의 환자 중 와파린(n = 53)이나 항혈전제(n = 105)를 투여받는 CHA<sub>2</sub>DS<sub>2</sub>-VASc 점수 1점 이상의 158명(나이, 63.7 ± 12.2세; 남성, n = 103)이 본 연구에 포함되었다. 결과: 총 추적 조사 기간 동안(31.0 ± 29.4개월), 10건의 혈전색전 사건과 29건의 주요 출혈 사건이 발생하였다. 혈전색전 사건의 발생은 와파린군과 항혈전제군 사이에 유의한 차이를 보이지 않았다(1.9%와 8.6%, p = 0.166). 주요 출혈 사건의 발생은 항혈전제군보다 와파린군에서 유의하게 높은 발생률을 보였다(32.1%와 11.4%, p = 0.002). 와파린의 사용은 주요 출혈 사건 발생을 증가시키는 주요한 위험인자였으나(HR, 3.44; 95% CI, 1.60-7.36; p = 0.001) 혈전색전 사건의 발생의 감소와는 통계적으로 유의한 관계를 보이지 않았다(HR, 0.34; 95% CI, 0.04-2.70; p = 0.306). 결론: 심방세동과 말기 콩팥병을 동반한 환자에서 와파린의 사용은 항혈전제와 비교하였을 때 출혈 사건의 위험을 증가시킨다. 결론: 심방세동과 말기 콩팥병을 동반한 환자에서 와파린의 사용은 항혈전제와 비교하였을 때 출혈 사건의 위험을 증가시킨다. Background/Aims: The optimal strategy for anticoagulation treatment in patients with atrial fibrillation (AF) and end-stage renal disease (ESRD) has not been established. We evaluated the efficacy and bleeding risk of warfarin and antiplatelet agents in patients with AF and ESRD. Methods: We retrospectively reviewed the medical records of 256 patients with AF and ESRD and included 158 patients (age, 63.7 ± 12.2 years; male sex, n = 103) with a CHA<sub>2</sub>DS<sub>2</sub>-VASc score ≥ 1 who were taking warfarin (n = 53) or an antiplatelet agent (n = 105). Results: During the follow-up period (31.0 ± 29.4 months), 10 ischemic events and 29 major bleeding events occurred. The thromboembolic event rate did not significantly differ between the warfarin and antiplatelet groups (1.9% and 8.6%, respectively; p = 0.166). However, the rate of major bleeding events was significantly higher in the warfarin group than it was in the antiplatelet group (32.1% and 11.4%, respectively; p = 0.002). Cox’s regression analysis indicated that warfarin was related to an increased risk of major bleeding events (hazard ratio [HR], 3.44; 95% confidence interval [CI], 1.60-7.36; p = 0.001). Conversely, warfarin was not related to a decreased risk of thromboembolic events (HR, 0.34; 95% CI, 0.04-2.70; p = 0.306). Conclusions: In patients with AF and ESRD, warfarin use was associated with an increased risk of bleeding events, compared with antiplatelet agents. (Korean J Med 2019;94:191-199)
2021 대한부정맥학회 심방세동 환자의 특수 임상 상황 환자군에서 ABC Pathway 치료 지침
황유미 ( You Mi Hwang ),임홍의 ( Hong Euy Lim ),이대인 ( Dae In Lee ),유희태 ( Hee Tae Yu ),박예민 ( Yae Min Park ),정보영 ( Boyoung Joung ) 대한내과학회 2021 대한내과학회지 Vol.96 No.4
Optimized management of atrial fibrillation requires patient-oriented decision making with a multidisciplinary approach. This report incorporates recent authoritative studies to provide detailed recommendations for managing atrial fibrillation in specific clinical settings. The principles of the Atrial fibrillation Better Care (ABC) pathway apply in these clinical settings. In addition, specific considerations are discussed for each of these conditions and populations. (Korean J Med 2021;96:264-295)
2018 대한부정맥학회 NOAC 사용 지침: 특별한 상황에서의 약물 복용(관상동맥질환, 용량 혼동시, 심율동 전환, 뇌졸중 발생, 악성종양) 및 기타
박예민 ( Yae Min Park ),박형욱 ( Hyung Wook Park ),이정명 ( Jung Myung Lee ),박진규 ( Jin-kyu Park ),이기홍 ( Ki Hong Lee ),김진배 ( Jin-bae Kim ),이영수 ( Young Soo Lee ),정보영 ( Boyoung Joung ) 대한내과학회 2019 대한내과학회지 Vol.94 No.1
Non-vitamin K antagonist oral anticoagulants (NOACs) are an alternative to vitamin K antagonists (VKAs) and have emerged as the treatment of choice in Korea. However, several questions remain regarding the optimal use of these agents in specific clinical situations. In this paper we discuss 1) patients with atrial fibrillation (AF) and coronary artery disease, 2) avoiding confusion with NOAC dosing across indications, 3) cardioversion in a patient treated with a NOAC, 4) AF patients who present with acute stroke while on NOACs, 5) NOACs in special situations, 6) anticoagulation in AF patients with a malignancy, and 7) optimizing VKA dose adjustments. (Korean J Med 2019;94:57-82)
2018 대한부정맥학회 심방세동 위험인자와 동반된 심혈관계 질환의 발견과 관리
이소령 ( So-ryoung Lee ),이영수 ( Young Soo Lee ),임우현 ( Woo-hyung Lim ),김태훈 ( Tae-hoon Kim ),차명진 ( Myung-jin Cha ),이지현 ( Ji-hyun Lee ),백용수 ( Yong-soo Baek ),임홍의 ( Hong Euy Lim ),정보영 ( Boyoung Joung ),김준수 ( 대한내과학회 2018 대한내과학회지 Vol.93 No.4
A number of concomitant conditions and cardiovascular diseases are closely related to the development of atrial fibrillation (AF), AF recurrence, and AF-associated complications. Detection, prevention, and treatment of such conditions are essential for the prevention of AF and its disease burden. This article discusses the clinical conditions and concomitant diseases associated with AF including heart failure, hypertension, diabetes, obesity, chronic respiratory diseases, and kidney disease based on the 2016 European Society of Cardiology guidelines for the management of AF and recently updated clinical data, particularly in patients with heart failure. Furthermore, we provide recommendations for the prevention, diagnosis, and management of these conditions.