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Pocket Guidelines

for the Management of Patients with Atrial Fibrillation

A Report of the American College 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).

Developed in Collaboration With the North American Society of Pacing and
Electrophysiology

Co-chairperson: Co-chairperson:
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
Phone:(46) 8 5177 2171 Phone:(1) 212 241 7911
Fax: (46) 8 31 10 44 Fax: (1) 212 423 9488
E-mail:lars.ryden@ks.se E-mail: valentin.fuster@msnyuhealth.org
lars.ryden@medks.ki.se

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


ESC Staff:
1.Keith McGregor, Sophia-Antipolis, France
2.Veronica Dean, Sophia-Antipolis, France
3.Dominique Poumeyrol, Sophia-Antipolis, France
4.Catherine Despres, Sophia-Antipolis, France
5.Xue Li, Sophia-Antipolis, France

*Adapted from the ACC/AHA/ESC Guidelines for the Management of Patients
with Atrial Fibrillation (European Heart Journal, 2001; 22; 1852-1923)



1
Ea?iaiiue Ni?aai?iee ii aaaaie? aieuiuo n ia?oaoaeuiie
a?eoieae

Ia?aaaaai ia ?onneee ycue n i?eaeiaea. I?eaeiae ainooiai ia
naeoa

www.escardio.org

Ia?aaia i?iaaaai eeeieeie AEA e
niaeaniaai n Aa?iiaeneie Annioeaoeae Ea?aeieiaia e
Annioeaoeae Ea?aeieiaia A?iaiee

?aaaeoi? ia?aaiaa A?. Eeaia Oa?ao?yi

Yoio ni?aai?iee e iiiaea a?oaea o?aaiua iaoa?eaeu ii?ii
iaeoe ia naeoa eeeieee AEA

www.acg.am




2
NIAA??AIEA


I. Введение………………………………………………… ст. 4

II. Класификация…………………………………………… ст. 6


III. Yieaaieieiaey.………………………………………… ст. 8

IV. Keeie?aneia
ianeaaiaaiea.…………………………………………… ст. 8

V. Iaci? aeai?eoiia ea?aiey iaoeaioia n IA (ni. ?en. 2, 3, 4 e
5).…………………………………………………………ст. 10

VI. ?aeiiaiaaoee aey ea?aiey iaoeaioia n IA ………… ст. 16

VII. ?aeiiaiaaoee aey ea?aiey iaoeaioia, o eioi?uo IA
?acaeaaaony ai a?aiy ?acee?iuo caaieaaaiee……………… ст. 38




3
I. Введение

Ia?oaoaeuiay A?eoiey (IA) – yoi iaeaieaa ?anoi ano?a?a?uaany
ia?ooaiea ?eoia na?aoa, ec oae iacuaaaiuo noieeeo, iinoiyiiuo
ia?ooaiee ?eoia. ?anoioa ano?a?aaiinoe IA oaaee?eaaaony n
aic?anoii iaoeaioia. IА ii?ao ?anoi nii?iai?aaou различные
заболевания сердца, хотя nouanoaaiiay ?anou iaoeaioia n IА ia
eiaao ii?aaaeaiiie no?oeoo?iie iaoieiaee.

Oooaoaiey aaiiaeiaieки e o?iiaiyiaiee?aneea inei?iaiey,
naycaiiua n IА привoдят к выраженному iiauoaieю
caaieaaaaiinoe, nia?oiinoe и стоимости caaieaaaiey. Iiyoiio
Aia?eeaineay Koeeaaey Ea?aeieiaia (American College of
Cardiology-ACC), Aia?eeaineay Na?aa?iay Annioeaoey (American
Heart Assosiation-AHA) e Aa?iiaeneia Iauanoai Ea?aeieiaia
(European Society of Cardiology-ESC) iniiaaee eiieoao экспертов
для nicaaiey ?oeiaianoaa ii мерцательной a?eoiee.


Как и другие ACC/AHA руководства, этот документ применяет
классификацию ACC/AHA – I, II, III классов, которые приведены
справа.




4
?aeiiaiaaoee, i?eaaaaiiua a oaaeeoa, aee??a?o eae aaiiua
aieacaoaeuiie iaaeoeiu, oae e iiaiey yenia?oia:

Eeann I – aanie?oiua iieacaiey:
Ninoiyiey, i?e eioi?uo eiaaony iauay niaeaniaaiiinou
e/eee aaiiua aieacaoaeuiie iaaeoeiu naeaaoaeunoao?o i
oii, ?oi aiaoaoaeunoai (i?ioaao?a eee ea?aiea) iieacii e
yooaeoeaii.

Eeann II - ioiineoaeuiua iieacaiey:
Ninoiyiey, i?e eioi?uo iao iauae niaeaniaaiiinoe e/eee
aaiiua aieacaoaeuiie iaaeoeiu ?anoiayony ai iiaieyo i
iieaciinoe e yooaeoeaiinoe aiaoaoaeunoaa (i?ioaao?u eee
ea?aiey). Yoio eeann eiaao aaa iiaoeia:
Eeann IIa - ioiineoaeuiua iieacaiey:
Aieacaoaeuiay iaaeoeia eee iiaiey yenia?oia aieuoa
neeiiy?ony a noi?iio i?iaaaaiey i?ioaao?u eee ea?aiey.

Eeann IIb - ioiineoaeuiua i?ioeaiiieacaiey:
Iieaciinou / yooaeoeaiinou i?ioaao?u iaiuoa iainiiaaia
aieacaoaeuiie iaaeoeiie eee iiaieyie yenia?oia.


Eeann III - aanie?oiua i?ioeaiiieacaiey:
Ninoiyiey, i?e eioi?uo eiaaony iaoay niaeaniaaiiinou
e/eee aaiiua aieacaoaeuiie iaaeoeiu naeaaoaeunoao?o i
oii, ?oi aiaoaoaeunoai (i?ioaao?a eee ea?aiea) IAiieacii
e IAyooaeoeaii, a a iaeioi?uo neo?ayo ii?ao auou e
a?aaii.




5
II. Eeanneoeeaoey
• Ia?oaoaeuiay A?eoiey ii?ao eiaou ?acee?iua eeeie?aneea
i?iyaeaiey, e ii?ao iaae?aaony eae i?e iaee?ee, oae e ai a?aiy
ionoonaey no?oeoo?iiai caaieaaaiey na?aoa. Iai?eia?, oa?iei
‘Lone’ IA - ‘eciee?iaaiiay oi?ia’ IA, eiaao ?acee?iua
ii?aaaeaiey. I?iaiic a ioiioaiee o?iiaiyiaieee e nia?oiinoe
aieaa aeaaii?eyoai, o iieiauo eiaeaeaooiia (aic?ano iiei?a 60
eao) aac eeeie?aneeo eee yoiea?aeia?aoe?aneeo i?iyaeaiee
na?aa?ii-eaai?iuo caaieaaaiee, eioi?ua e ninoaaey?o a?oiio
‘Lone’ IA. N aic?anoii eee i?e ?acaeoee no?oeoo?iuo ia?ooaiee
na?aoa iaoeaiou auauaa?o ec a?oiiu ‘Lone’ IA, e ?ene
o?iiaiyiaieee e nia?oiinoe aic?anoaao. ‘Lone’ IA ioee?aaony io
eaeiiaoe?aneie oi?iu IA. Iineaaiyy oeacuaaao ia oi, ?oi
i?ienoi?aaiea IA ia ecaanoii e ia eiaao nnueie ia aic?ano
iaoeaioia eee ia no?oeoo?iua caaieaaaiey na?aa?ii-ninoaenoie
nenoaiu. Oa?iei ‘iaeeaiaiiay’ IA oneiaii oa?aeoa?ecoao oieuei
neo?ae, eiaaa IA aicieeaao i?e ionoonoaee ?aaiaoe?aneiai
ieo?aeuiiai noaiica eee eneonnoaaiiuo eeaiaiia na?aoa.

• Eeanneoeeaoeiiiay noaia, ?aeiiaiaiaaiiay ie?a, i?aanoaaeyao
ni?aoaiea ?aeaaiie i?inoiou e eeeie?aneee aa?iinoe. Eeeieoeno
aie?ai ii?aaaeeou ia?aue yiecia IA, ia caaeneii io oiai aue ee
ii neiioiiaoe?iui, eee i?ioaeae aacneiioiiii, o?eouaaou
aicii?iua iaoi?iinoe a ioaiea i?iaie?eoaeuiinoe i?enooia,
iaee?ey ia auyaeaiiuo i?enooiia. Anee o iaoeaioa auee 2 eee
aieaa yieciaia, IA n?eoaaony iiaoi?iie. Anee iiaoi?iay IA
i?a?uaaaony naiii?iecaieuii, iia oa?aeoa?ecoaony eae
ia?ieneciaeuiay; a anee iao – iacuaaaony ia?nenoaioiie.
I?ae?auaiea i?enooia oa?iaeieiae?aneie oa?aieae eee
yeaeo?e?aneie ea?aeiaa?neae ia?aa i?eaaaiui niiioaiiui
ainnoaiiaeaieai neioniaiai ?eoia ia iaiyao ii?aaaeaiey a?eoiee
eae ia?ieneciaeuiie. Ia?iaiaioiay oi?ia IA aee??aao neo?ae
aeeoaeuiie IA (iai?eia?, nouanoao?uae aieaa 1 aiaa), eiaaa
ea?aeiaa?ney ia auea iieacaia eee ia auea i?eiaiaia.




6
Ana oeacaiiua oa?ieiu ioiinyony e IA, eioi?ay aeeony aieaa 30
naeoia e ia yaeyaony neaanoaeai ia?aoeiuo ninoiyiee. IA,
aicieeoay a ?acoeuoaoa i?iaioe?o?ueo ninoiyiee, oaeeo eae
ino?ue eioa?e ieiea?aa, oe?o?aee ia na?aoa, ieiea?aeou,
aeia?oe?aieaeci eee ino?uo eaai?iuo caaieaaaiee,
?anniao?eaaaony ?acaaeuii. A oaeeo neo?ayo, ea?aiea iniiaiie
iaoieiaee (aianoa n neiioiiaoe?aneei ea?aieai ii iiaiao IA)
iau?ii i?eaiaeo e i?ae?auaie? a?eoiee.



?enoiie 1. Oa?aeoa?enoeea IA


Aia?aua
?aaeno?e?iaaiiay
IA




Ia?ieneciaeuiay 1,4 Ia?nenoaioiay 2,4
(naiii?iecaieuii ia
(naiii?iecaieuii
i?a?uaaaony) i?a?uaaaony)




Ia?iaiaioiay 3


1. Yieciau, i?iaie?eoaeuiinou eioi?uo iaiuoa eee ?aaia 7 aiyi (?aua
iaiaa 24 ?ania);
2. iau?ii i?iaie?eoaeuiinou aieaa 7 aiae;
3. ea?aeiaa?ney ia aaea oi?ioeo ?acoeuoaoia eee ia auea i?eiaiaia;
4. e ia?ieneciaeuiay, e ia?nenoaioiay oi?iu IA iiaoo auou
iiaoi?iuie (recurrent).


7
III. Yieaaieieiaey
IA – naiay ?anoay e eeeie?anee cia?eiay a?eoiey. IA
ano?a?aaony o 0.4% e?aae a iauae iiioeyoee. Ano?a?aaiinou aa
oaaee?eaaaony n aic?anoii iaoeaioia.

IV. Keeie?aneia ianeaaiaaiea
Oaaeeoa 1. Ieieiaeuiia e aiaaai?iia ianeaaiaaiey iaoeaioa n IA

Ieieiaeuiia ianeaaiaaiea
1.Enoi?ey aieacie e 2. YEA, ?oiau ii?aaaeeou:
• ?eoi (eee ii?aaaeeou iaee?ea
oeceeaeuiua enneaaiaaiey,
?oiau ii?aaaeeou: IA)
• Iaee?ea neiioiiia i?e • Aeia?o?ioe? E?
IA e eo oa?aeoa?enoeeo. • Aeeoaeuiinou e ii?oieiae? P
• Eeeie?aneee oei IA coaoia eee oea?eeeyoi?iuo aiei
(ia?aue yiecia; oi?io: • Iaee?ea neia?iia
ia?ieneciaeuiay, i?aaaicao?aaiey ?aeoai?eia
ia?nenoaioiay eee (neia?ii AIA)
ia?iaiaioiay) • Aeieaao ii?ae io?ea Aena
• Aicieeiiaaiea ia?aie • I?aauaouee EI
neiioiiaoe?aneie aoaee • A?oaea i?aana?aiua a?eoiee
IA eee aaoo iaia?o?aiey • Oe?eio QRS, RR e QT
IA eioa?aaeia e n?aaiaiey
• ?anoioo, aeeoaeuiinou, eaea?noaaiiai aicaaenoaey ia ieo
niinianoao?uea oaeoi?u
3. ?aioaaiia?aoey a?oaiie eeaoee aey
e iaoaieci i?a?uaaiey
enneaaiaaiey:
IA
• Ia?aioeiu eaaeeo, anee
• Ioaao ia iacia?aiiua
eeeie?aneea enneaaiaaiey
oa?iaeieiae?aneea
i?aaiieaaa?o iaoieiae?
i?aia?aou
• Eaai?iie aaneoey?ecaoee, anee
• Iaee?ea na?aa?iiai
eeeie?aneea enneaaiaaiey
caaieaaaiey eee a?oaeo
i?aaiieaaa?o iaoieiae?
ia?aoeiuo ninoiyiee (i.?.
aeia?oe?aieaeci eee
i?eai aeeiaiey)




8
Ieieiaeuiia ianeaaiaaiea (i?iaie?aiea)
4. YOI-EA aey ii?aaaeaiey: 5. Aiaeec e?iae ia ai?iiiu ueoiaeaiee
• Eeaiaiiuo iaoieiaee na?aoa ?aeacu:
• ?acia?ia II e EI • Aey ia?aiai yieciaa IA, eiaaa
• ?acia?ia e ooieoee E? ?aeoai?eiaue ?eoi o?oaii
• Ieeiaiai aaaeaiey a I? eiio?iee?oaony, eee eiaaa IA
(eaai?iay aeia?oiiey) iai?eaaiii aiciaiiaeyaony iinea
• Aeia?o?ioee E? ea?aeiaa?nee
• O?iiaia EI (ieceay
?oanoaeoaeuiinou i?e
o?ainoi?aeaeuiii iaoiaa)
• Caaieaaaiey ia?eea?aa



Aiiieieoaeuiua oanou.
Iaei eee ianeieuei oanoia iiaoo iiiaaiaeouny .
Iaa?oci?iua oanou: O?ainycioaaaaeuiay YOIea:
• Eiaaa aaaeaaoiinou eiio?iey • Aey ii?aaaeaiey o?iiaia EI
?NN iia aii?inii (i?e (ooea EI)
• Aey i?iaaaaiey ioaiee ooieoee
ia?iaiaioiie IA)
• Aey aini?iecaaaaiey IA, na?aoa ai e iinea ea?aeiaa?nee
eiaooe?iaaiiie iaa?oceie
• Aey enee??aiey eoaiee ia?aa
ia?aeii ea?aiey
aioea?eoie?aneeie i?aia?aoaie
eeanna IC

Oieoa? iiieoi?eia eee Event: YOE:
• Eiaaa aeaaiic eee oi?ia a?eoiee • Aey auyniaiey iaoaiecia
iia aii?inii oaoeea?aee n oe?ieeie
• Aey eiio?iey ?NN eiiieaenaie QRS
• Aey ii?aaaeaiey a?eoiee,
iiaeaeoeo ca niaie IA, i-?. OI
(o?aiaoaiea i?aana?aee) eee
ia?ieneciaeuiua
iaa?aeoai?eiaua oaoeea?aee.
• Aey ii?aaaeeaiey o?anoeia aey
ea?aaiie aaeyoee; eee aey
aaeyoee/iiaeoeeaoee AA ocea.


AIA – neia?ii Aieuoa- Ia?eeiniia- Aaeoa, EI – eioa?eo ieiea?aa, E? –
eaaue ?aeoai?ae, II – i?aaia i?aana?aea, EI – eaaia i?aana?aea, ?NN -
?anoioa na?aa?iuo nie?auaiee, OI – o?aiaoaiea i?aana?aaee.


9
Oaaeeoa 2. Eeanneoeeaoey aioea?eoie?aneeo i?aia?aoia ii Vaughan Williams-o

• ? – aeieaoi?u,
• Aeciie?aiea
Eeann IA Eeann II
• I?ieaeiaiea (i-?,
I?ii?aiieie)
(Iiaieaeiaiea)
• Oeieaei
• Eeaieaei •
Eeann IA Eeann III Aieiaa?ii
• Iaeneeaoei • A?aoeeeoi
• Aioaoeeea
• Eaooeeea
• Nioaeie

• Oeaeaeiea • Aioaaiienou
Eeann IN Eeann IV
• Ii?eoecei eaeuoeaauo
eaiaeia (i-?
• I?iiaoaiii
Aa?aiaiee e
Aeeoeacai).

Iiaeoeeaoey ?ac?aoaia Vaugan Williams AI. J Clin Pharmacol 1984; 24: 129-47.
©1984 – Sage Pablications Inc.-ii, aey aee??aiey i?aia?aoia, eioi?ua auee nicaaiu iinea
ioaeeeaoee iniiaiie eeanneoeeaoee.



V. Iaci? aeai?eoiia ea?aiey iaoeaioia n IA (ni. ?en. 2, 3, 4 e 5)
Aey ea?aiey iaoeaioia n IA iaiaoiaeii ciaou ana i?eciaee aicieeiiaaiey
a?eoiee (ia?ieneciaeuiie, ia?nenoaioiie, ia?iaiaioiie) e i?eiyou ?aoaiea i
ainnoaiiaeaiee e iiaaa??aiee neioniaiai ?eoia, eiio?iea ?aeoai?eiaiai
?eoia e ia aioeeiaaoeyoeiiiie oa?aiee. Ana yoe aii?inu i?aanoaaeaiu a
aeai?eoiao aey ea?aie oi?iu IA.




10
?enoiie 2. .Eaea?noaaiiay oa?aiey aia?aua auyaeaiiie IA



Aia?aua
auyaeaiiay
IA




Ia?ieneciaeuiay Ia?nenoaioiay




Ai iiyaeaiey
au?a?aiiuo
Aiionoeou Aioeeiaaoeyoey e
neiioiiia
ia?iaiaioio? IA eiio?ieu ?NN ii
(aiiioaicey, NI,
iaiaoiaeiinoe (ni.
noaiiea?aee) –
Oaae.9 e 10)
oa?aiey ia io?ia



Aioeeiaaoeyoey e I?aaiieaaaaony
Aioeeiaaoeyoey – eiio?ieu ?NN ii aioea?eoie?aneay
ii iaiaoiaeiinoe iaiaoiaeiinoe (ni. eaea?noaaiiay

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