Fazekas Tamás, Csanádi Zoltán, Varró András
Szegedi Tudományegyetem, Szent-Györgyi Albert Orvos- és Gyógyszerésztudományi Centrum, Altalános Orvostudományi Kar, I. Belgyógyászati Klinika.
Orv Hetil. 2003 Jun 15;144(24):1199-206.
The authors summarize the up-to-date knowledge relating to the pharmacological treatment of atrial fibrillation. They emphasize that drug treatment continues to be in the forefront of the therapy of the arrhythmia, which can now be considered to constitute a cardiovascular epidemic. In the era following the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AF-FIRM) trial, the strategy of pharmacological treatment will certainly change: in place of "rhythm control", which in recent decades has been overforced in patients identical with the elderly, cardiac patients with an impaired left ventricular function who were enrolled into AFFIRM, there will be a more frequent use of ventricular "rate control". Naturally, this does not mean that, in certain patient groups, an effort should not be made to restore and maintain the sinus rhythm. In cases involving congestive heart failure and structural heart disease complicated by a depressed left ventricular systolic function, atrial fibrillation is currently treated with antiarrhythmic drugs possessing low proarrhythmic activity that prolong refractory period (Class 3), and with the even safer mortality-reducing beta-receptor blockers. The classical antiarrhythmic drugs (quinidine, procainamide, disopyramide) are being increasingly forced into the background, and the areas of indication of the novel Na(+)-channel blocker antiarrhythmics (propafenone, flecainide) have also narrowed: they are administered only in the event of atrial fibrillation in patients with a structurally intact heart or left ventricular hypertrophy. After a brief survey of the more important aspects of ventricular rate control, and of the drugs available, the research trends aimed at the progression of the pharmacological treatment of atrial fibrillation are outlined. The clinical introduction of procedures based on myocardial gene therapy is now a realistic therapeutic approach as concerns atrial fibrillation too.
作者总结了与房颤药物治疗相关的最新知识。他们强调，药物治疗在这种心律失常的治疗中仍然处于前沿地位，如今房颤可被视为一种心血管流行病。在房颤节律管理随访研究（AF-FIRM）试验之后的时代，药物治疗策略肯定会发生变化：在近几十年来对与AFFIRM研究中纳入的老年、左心室功能受损的心脏病患者过度强化的“节律控制”之外，将会更频繁地使用心室“率控制”。当然，这并不意味着在某些患者群体中，不应努力恢复和维持窦性心律。在涉及充血性心力衰竭和伴有左心室收缩功能降低的结构性心脏病的病例中，目前房颤的治疗使用具有低促心律失常活性、延长不应期的抗心律失常药物（第3类），以及更安全的可降低死亡率的β受体阻滞剂。经典抗心律失常药物（奎尼丁、普鲁卡因胺、丙吡胺）正日益退居幕后，新型钠通道阻滞剂抗心律失常药物（普罗帕酮、氟卡尼）的适应证范围也已缩小：仅用于心脏结构完整或左心室肥厚患者发生房颤的情况。在简要概述心室率控制的更重要方面以及可用药物之后，概述了旨在推进房颤药物治疗的研究趋势。基于心肌基因治疗的程序在临床上的应用如今对于房颤来说也是一种现实的治疗方法。
