Deantonio H J, Movahed A
East Carolina University School of Medicine, Greenville, North Carolina.
Am Fam Physician. 1992 Jun;45(6):2576-84.
Atrial fibrillation is associated with potentially life-threatening strokes. Anticoagulation with warfarin or aspirin reduces the risk of embolic events in patients with chronic atrial fibrillation and mitral valve stenosis or other underlying heart disease. In patients with acute onset of atrial fibrillation, anticoagulation is not necessary before cardioversion. However, in patients with chronic atrial fibrillation, anticoagulation should be started three weeks before cardioversion and continued for four weeks after the return of normal sinus rhythm. Quinidine remains the agent most commonly used for medical cardioversion in patients who are hemodynamically stable. If a patient is hemodynamically unstable or the atrial fibrillation is not corrected with drug therapy, direct-current electrical cardioversion has a high success rate. Antiarrhythmic (quinidine) therapy is often continued indefinitely to help maintain sinus rhythm.
心房颤动与潜在的危及生命的中风有关。使用华法林或阿司匹林进行抗凝可降低慢性心房颤动合并二尖瓣狭窄或其他潜在心脏病患者发生栓塞事件的风险。对于急性发作的心房颤动患者，在进行心脏复律前无需抗凝。然而，对于慢性心房颤动患者，应在心脏复律前三周开始抗凝，并在恢复正常窦性心律后持续四周。奎尼丁仍然是血流动力学稳定的患者进行药物心脏复律最常用的药物。如果患者血流动力学不稳定或药物治疗未能纠正心房颤动，直流电心脏复律成功率很高。抗心律失常（奎尼丁）治疗通常会无限期持续以帮助维持窦性心律。
