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<title>心房細動のトータルマネジメント（電子版のみ） | 株式会社文光堂</title>


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<meta name="description" content="心房細動は最もありふれた不整脈である．従来より不整脈をどう治療するかに関心が向けられていたが，決して心房細動患者の生命予後は良くないことがわかってきた．しかし昨今新しい抗凝固薬が出されたことにより，心原性脳塞栓症を予防し，生命予後の改善をする基盤が整いつつある．本書では，抗不整脈薬を漫然と使うことを避け，「脈のコントロールから生命予後の改善へ」を治療姿勢として，心房細動のトータルマネジメントを行う">

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		<h1 class="catchCopy">心房細動治療の常識が変わる！</h1>
		

		<h1 class="title">心房細動のトータルマネジメント（電子版のみ）<span class="version"></span></h1>
		<h2 class="subTitle">治療の常識が変わる！</h2>

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					編集：伊藤　浩（岡山大学教授）
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				<ul class="property"><li class="disc">B5判・224頁・4色刷</li><li class="disc">ISBN&nbsp;978-4-8306-1922-9</li><li class="disc">2014年3月10日発行</li></ul>

				
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">心房細動は最もありふれた不整脈である．従来より不整脈をどう治療するかに関心が向けられていたが，決して心房細動患者の生命予後は良くないことがわかってきた．しかし昨今新しい抗凝固薬が出されたことにより，心原性脳塞栓症を予防し，生命予後の改善をする基盤が整いつつある．本書では，抗不整脈薬を漫然と使うことを避け，「脈のコントロールから生命予後の改善へ」を治療姿勢として，心房細動のトータルマネジメントを行うための考え方や方法をまとめた．</section><section class="preface">序　文<br><br>　心房細動は最もありふれた不整脈です．そして，我々の関心も不整脈をどう治療するかに向けられていました．しかし， 疫学的検討から心房細動患者の生命予後がとても悪いことが明らかとなってきました．新規心房細動患者では診断後半年以内に何と15％以上死亡するというデータもあります．いくつかの要因が考えられますが，最も重要なものは心原性脳塞栓症です．患者の生命予後を改善し，健康寿命を延ばすためには，抗凝固療法により脳塞栓症を予防することが必須です．それは，新規心房細動であっても，発作性そして持続性であっても同じです．しかし，現実には抗凝固療法が徹底されているとは言えません．ワルファリンは用量調節が面倒くさい，特に高齢者では出血リスクが怖いため使いにくい，そして予防治療であることからその効果を医師も患者も実感しにくい，など使いたくない理由を数えたらきりがありません．それに対して，治療効果はワルファリンと同等かそれ以上，そして安全性がワルファリンよりも高くモニターの必要がない新規抗凝固薬が市販されたことにより，抗凝固療法を積極的に実践する基盤は整ったと言えるでしょう．高齢者だからこそ，健康寿命を維持するための抗凝固療法，その決意を強く持って診療に臨んでいただきたいと思います．<br>　心房細動患者は心不全の高リスク群でもあります． 拡張不全症例が多いうえに， 心房細動になると左室充満における心房収縮の関与が喪失し，そして頻拍による拡張時間の短縮が心不全のトリガーになります．レートコントロールは抗凝固療法とともに治療戦略の基盤をなすものです．β遮断薬が推奨されていますが，徹底されていないのも現状です．他方，ⅠaあるいはⅠc群の抗不整脈薬が漫然と使用されているのも目につきます．これは，器質的心疾患を有する患者では致命的な合併症を起こす危険もあるため注意すべきことです．リズムコントロールということであれば，カテーテルアブレーションが有効な手技です．発作性心房細動の段階であれば根治を目指すことも可能です．現状では，その適応基準があいまいなため，現場で混乱しているのも事実です．<br>　心房細動治療は，「脈のコントロールから生命予後の改善へ」というように大きく変貌しています．心房細動のトータルマネジメントの最新情報をエキスパートの先生にまとめていただいたのが本書の目的です．明日からの診療にお役立ていただことが，筆者一同の心からの願いです．<br><br>2014年3月吉日<br>岡山大学大学院医歯薬学総合研究科循環器内科学<br>伊藤　浩</section><section class="indexes">I はじめに─心房細動診療の常識が変わった！─<br>II 治療の常識が変わった！<br>　A． 抗凝固療法は必須─では具体的にどうする？─<br>　　1．心房細動による脳卒中はきわめて重篤である<br>　　2．基本は抗凝固療法，しなくてよいのはどのような症例？<br>　　　Controversy：CAHDS2スコアにおける年齢の重要性<br>　　　One Point Advice：アスピリンはなぜ外された？<br>　　3．凝固カスケードと抗凝固薬の作用機序をわかりやすく説明しましょう<br>　　4．直接トロンビン阻害薬のエビデンスと使い方<br>　　5．Xa阻害薬のエビデンスと使い方<br>　　　One Point Advice：なぜ新規抗凝固薬では出血性合併症が少ないか<br>　　　Topics：エドキサバンの心房細動に対する効果<br>　　6．新規抗凝固薬をどのように使い分けたらよいか<br>　　　One Point Advice：ワルファリンから新規抗凝固薬への切り替えをどうする<br>　　7．ワルファリンが推奨される症例<br>　　　One Point Advice：PT-INRコントロールの目標値1.6～2.6 vs. 2.0～3.0<br>　　8．高齢者・腎不全患者における抗凝固薬をどうするか<br>　　　One Point Advice：出血性合併症が起きたときの対応<br>　　　One Point Advice：手術前後の抗凝固薬の使い方<br>　　　One Point Advice：薬剤溶出性ステント後の抗血小板・抗凝固療法<br>　B． レートコントロールは心房細動治療の基礎である<br>　　1．レートコントロールはすべてのタイプの心房細動治療のベースとなる<br>　　2．基本はβ遮断薬，ジギタリス製剤とカルシウム拮抗薬についてはどうか？<br>　　　One Point Advice：β遮断薬の具体的な使用法<br>　　　Topics 意外と知られていないジゴキシンの欠点<br>　　　One Point Advice：「アブレーション＆ペーシングの適応<br>　C． カテーテルアブレーションを有効に活用する<br>　　1．発作性心房細動では根治させることも可能になってきた<br>　　2．カテーテルアブレーションの手技を解剖とともに説明しましょう<br>　　3．慢性心房細動患者におけるカテーテルアブレーションの適応と限界<br>　　　Controversy：カテーテルアブレーションのリスク<br>　　　One Point Advice：カテーテルアブレーション後の再発にはどう対処する？<br>　　4．カテーテルアブレーションで心機能と生命予後は改善するか？<br>　　5．カテーテルアブレーション後の後療法─抗凝固薬と抗不整脈薬─<br>　　　Controversy：カテーテルアブレーションの長期成績─心房細動は再発している─<br>　D． 抗不整脈薬によるリズムコントロールは限定的<br>　　1．初発心房細動における薬物治療戦略<br>　　2．電気的リモデリングと抗不整脈薬の選択<br>　　3．知っておくべきチャネルブロッカーのリスク<br>　　4．アミオダロンに慣れよう<br>　　　One Point Advice：抗不整脈薬の“ベからず”集─抗不整脈薬投与でしてはいけないこと─<br>　E． 心房細動の原因を治療し予防しよう<br>　　1．降圧療法はとても重要<br>　　2．心房細動に対するω3多価不飽和脂肪酸のエビデンス<br>　　　Controversy：心房細動に対するアップストリーム治療<br>III 知っておくべき心房細動の知識あれこれ<br>　A． 心房細動の分類とその意義<br>　　1．初発，発作性，持続性，永続性心房細動の機序と病態の相違<br>　　2．解剖学的リモデリングと電気的リモデリング<br>　　　One Point Advice：器質的心疾患患者の心房細動は孤発性と何が違う？<br>　　　Topics：心房細動と自律神経<br>　B． 心房細動の合併症は血栓だけではない<br>　　1．注意すべき心房細動の臨床症状<br>　　2．心房細動は心不全のトリガーとなる<br>　　　Topics：頻脈誘発性心筋症とは？<br>　　　Topics：心房細動と認知症<br>　C． 心房細動患者にするべき検査とその意義<br>　　1．心エコー図検査では何を見るべきか<br>　　2．MDCTの役割─どのような症例に使って，何を見るか─<br>　　　One Point Advice： 心房細動患者にHolter心電図検査は必要か？<br>　　3．チェックしておくべき血液検査<br>索引</section></article>
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