현명내과

의학적 검토: 정지인 내과 전문의 / 류마티스내과 분과전임의 (서울대학교병원 전임의 과정 수료 (2021-2024))

영남대학교 의과대학 내과학 석박사 수료

최종 업데이트: 2026-04-17

개요

심방세동(AF, ICD-10: I48.91)은 가장 흔한 지속성 부정맥으로, 심방의 불규칙한 전기 활동으로 불규칙한 심박이 발생합니다. 뇌졸중 위험을 5배 증가시키며, 한국 성인의 약 1-2%가 이환되어 있고 고령화에 따라 증가하고 있습니다.

원인과 위험인자

분류세부 인자기전/특징
고령65세 이상 급증심방 섬유화, 전기적 리모델링
고혈압가장 흔한 동반 질환좌심방 압력 부하 → 확장
심부전/판막질환구조적 심질환심방 용적 부하
비만/수면무호흡대사성 위험인자AF 발생 및 재발 증가
음주명절 심장(holiday heart)급성 및 만성 AF 유발

증상

진단

심전도(ECG)

P파 소실 + 불규칙한 RR 간격이 진단의 핵심. 30초 이상의 AF 기록이 필요.

심초음파

좌심방 크기, 판막 이상, 좌심실 기능 평가. 혈전(좌심이) 확인에 경식도 심초음파.

CHA₂DS₂-VASc 점수

뇌졸중 위험 평가: 남 ≥1점, 여 ≥2점이면 항응고 권고.

치료

항응고 치료(뇌졸중 예방)

DOAC(직접 경구 항응고제: apixaban, rivaroxaban, edoxaban, dabigatran)가 와파린 대비 우월 또는 비열등하면서 출혈 위험 낮음 → 1차 권고.

심박수 조절

베타차단제, 비디히드로피리딘 CCB(diltiazem/verapamil)로 목표 심박수 <110/분(안정 시). 심부전 동반 시 digoxin 추가.

심율동 전환/유지

증상적 AF: 항부정맥제(flecainide, amiodarone) 또는 카테터 절제술(PVI). CASTLE-AF에서 심부전 동반 AF에 절제술이 약물 대비 우월.

PubMed 근거 요약

2020 ESC AF 가이드라인(Hindricks et al., Eur Heart J)은 ABC pathway(Anticoagulation, Better symptom control, Comorbidities)를 제시합니다. ARISTOTLE(Granger et al., 2011, NEJM)에서 apixaban이 와파린 대비 뇌졸중과 출혈 모두 유의하게 감소시켰습니다.

현명신경외과 류마티스내과의 접근

현명신경외과 류마티스내과에서는 심방세동의 진단(ECG, 심초음파), CHA₂DS₂-VASc 기반 항응고 치료, 심박수/리듬 조절을 제공합니다. 항응고제와 류마티스 약물(NSAIDs, 스테로이드)의 상호작용 관리에 주의를 기울입니다.

자주 묻는 질문

Q: 심방세동은 왜 위험한가요?

A: 심방에서 혈전이 형성되어 뇌졸중 위험이 5배 높아집니다. CHA₂DS₂-VASc 점수에 따라 항응고제(DOAC) 복용이 필요한지 결정합니다.

Q: 심방세동은 완치가 가능한가요?

A: 약물로 맥박수·리듬을 조절하며, 약물 불응 시 전극도자절제술(카테터 어블레이션)로 정상 리듬 회복을 시도할 수 있습니다. 성공률은 70~80%입니다.

Q: 심방세동이 있으면 반드시 혈액응고 방지제를 복용해야 하나요?

A: CHA2DS2-VASc 점수에 따라 결정됩니다. 남성 1점, 여성 2점 이상이면 항응고제가 권장됩니다. 최근에는 와파린 대신 NOAC(리바록사반, 아픽사반 등)가 출혈 위험이 낮아 선호됩니다.

Q: 심방세동은 어떤 증상이 나타나나요?

A: 두근거림, 어지러움, 호흡곤란, 운동 시 쉽게 지치는 증상이 흔합니다. 그러나 약 30%는 무증상이어서, 맥박 촉진이나 심전도 검사로 우연히 발견되기도 합니다.

참고 문헌

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함께 읽어보기

본 콘텐츠는 의학 논문과 임상 가이드라인을 기반으로 작성되었으며, 개인의 의료 상황에 따라 다를 수 있습니다. 정확한 진단과 치료는 전문의 상담을 통해 결정하시기 바랍니다.