JCS/JHRS 2020 Guideline on Pharmacotherapy of Cardiac Arrhythmias

Figures

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  Figure 1. Normal (A) and abnormal (B) automaticity, and triggered activities mediated by either early afterdepolarization (C) or delayed afterdepolarization (D).

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  Figure 2. (A) Leading circle theory (Source: Prepared base on Allessie MA et al. 1977 9 ). (B) Spiral wave reentry (Source: Prepared base on Pertsov AM et al. 1993 10 ). (C) Multiple rotors during ventricular fibrillation. Pivot points can be identified by convergence of all phases of the action potential (Source: Prepared base on Harada M et al. 2008 11 ).

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  Figure 3. Scheme for reentrant arrhythmia and effects of antiarrhythmic drugs. The situation where early exciation (premature contraction) (vertical arrow) penetrates in the reentrant circuit (blue circle) in vicinity of damaged tissue (gray or black box). (A) Without anti‐arrhyhmic drugs. (B) Drugs that reduce excitability, such as class I drugs. (C) Drugs that delay conduction, such as class IC drugs. (D) Drugs that prolong refractory period, such as class III drugs.

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  Figure 4. Pharmacokinetics (absorption, distribution, metabolism, and elimination).

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  Figure 5. Dose adjustment for patients with renal dysfunction: the Giusti‐Hayton method.

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  Figure 6. Acute treatment of narrow QRS supraventricular tachycardia. *1Off‐label use in Japan. *2Contralndicated in pts with reduced systolic function. ATP, adenosine triphosphate

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  Figure 7. Prophylactic therapy of supraventricular tachycardia. *1Off‐label use in Japan. WPW, Wolff‐Parkinson‐White.

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  Figure 8. Risk factors contributing to both atrial remodeling and formation of thrombus. DAD, delayed afterdepolarization; EAD, early afterdepolarization; ERP, effective refractory period; RAS, renin–angiotensin system; SAS, sleep apnea syndrome.

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  Figure 9. Classification of AF. AF, atrial fibrillation. (Source: Prepared based on Fuster V, et al. 2011, 202 Fuster V, et al. 2006. 203 ).

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  Figure 10. Flow chart for indication of ICM in patients with cryptogenic stroke. CT, computed tomography; CTA, computed tomography angiography; ECG, electrocardiogram; ICM, insertable cardiac monitor; MRA, mineralocorticoid‐receptor antagonist; MRI, magnetic resonance imaging; UCG, ultrasonic echocardiography. (Adapted from the Japan Stroke Society. 2016. 218 )

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  Figure 11. Incidence rates of ischemic stroke for each CHADS2 score. (A) Incidence rates of ischemic stroke with the original CHADS2 score (Adapted from Gage BF et al, 2001 245 ). (B) Incidence rates of ischemic stroke in Japanese patients not receiving anticoagulation therapy (pooled analysis of the J‐RHYTHM Registry, Fushimi AF Registry, and Shinken Database). (Adapted from Suzuki S et al, 2015 252 )

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  Figure 12. Anticoagulation therapy in AF. * 1 Bioprosthetic values are included in non‐valvular AF. *2Regarding anticoagulation according to renal function, see “3.2.3 Selection of Direct Oral Anticoagulants” and Table 36. *3Regarding target INR 1.6–2.6 in non‐valvular AF, INR close to 2.0 is recommended as possible. INR 2.0–3.0 may be considered in high‐risk patients aged <70 years with a history of stroke or CHADS2 score ≥3. AF, atrial fibrillation; DOAC, direct oral anticoagulant; INR, international normalized ratio; TIA, transient ischemic attack.