Naccarelli Gerald V, Hynes John, Wolbrette Deborah L, Bhatta Luna, Khan Mazhar, Luck Jerry
Hershey Medical Center, Division of Cardiology, 500 University Drive, Hershey, PA 17033, USA.
Curr Cardiol Rep. 2002 Sep;4(5):418-25. doi: 10.1007/s11886-002-0042-4.
In managing atrial fibrillation, the main therapeutic strategies include rate control, termination of the arrhythmia, and pr vention of recurrences and thromboembolic events. Rate control with digoxin, b-blockers, verapamil, and diltiazem may be preferred in drug refractory and sedentary patients with markedly dilated left atrium and atrial fibrillation of long duration. Drugs useful in the maintenance of sinus rhythm include quinidine, procainamide, disopyramide, sotalol, amiodarone, dofetilide, flecainide, and propafenone. In patients with structural heart disease, the class III antiarrhythmics are the initial drugs of choice, given their neutral effects on survival in a post-myocardial infarction and congestive heart failure population. Due to high recurrence rates with pharmacologic therapy, nonpharmacologic options of therapy include atrioventricular junction ablation, atrial defibrillators, catheter ablation of pulmonary vein foci, and attempts to perform an atrial Maze procedure using catheters. Hybrid therapy using drugs in combination with nonpharmacologic approaches will be used more frequently in the future for refractory patients.
在房颤的管理中，主要的治疗策略包括心率控制、心律失常的终止以及复发和血栓栓塞事件的预防。对于药物难治且久坐不动、左心房明显扩大且房颤持续时间长的患者，使用地高辛、β受体阻滞剂、维拉帕米和地尔硫䓬进行心率控制可能更为可取。可用于维持窦性心律的药物包括奎尼丁、普鲁卡因胺、丙吡胺、索他洛尔、胺碘酮、多非利特、氟卡尼和普罗帕酮。在有结构性心脏病的患者中，Ⅲ类抗心律失常药物是首选的初始药物，因为它们对心肌梗死后和充血性心力衰竭人群的生存率有中性影响。由于药物治疗的复发率较高，非药物治疗选择包括房室结消融、心房除颤器、肺静脉病灶的导管消融以及尝试使用导管进行心房迷宫手术。未来，对于难治性患者，将更频繁地使用药物与非药物方法相结合的联合治疗。
