McNamara Robert L, Tamariz Leonardo J, Segal Jodi B, Bass Eric B
Cardiovascular Section, Yale University School of Medicine, New Haven, Connecticut 06520-8017, USA.
Ann Intern Med. 2003 Dec 16;139(12):1018-33. doi: 10.7326/0003-4819-139-12-200312160-00012.
This review summarizes the available evidence regarding the efficacy of medications used for ventricular rate control, stroke prevention, acute conversion, and maintenance of sinus rhythm, as well as the efficacy of electrical cardioversion and the use of echocardiography in patients with atrial fibrillation.
The Cochrane Collaboration's database of controlled clinical trials and MEDLINE.
Primarily randomized, controlled trials of medications.
Paired reviewers obtained data on efficacy and safety. Strength of evidence was assessed.
Recent clinical trial results showed that most patients with atrial fibrillation have similar outcomes with strategies for controlling ventricular rate compared with strategies for restoring sinus rhythm. For efficacy of primary stroke prevention, compared with placebo, evidence was strong for warfarin and suggestive for aspirin. The evidence for an increased risk for major bleeding was suggestive for warfarin and inconclusive for aspirin. For ventricular rate control, verapamil, diltiazem, atenolol, and metoprolol were qualitatively superior to digoxin and placebo, particularly during exercise. For efficacy of acute conversion, compared with placebo, evidence was strong for ibutilide, flecainide, dofetilide, propafenone, amiodarone, and quinidine. For efficacy of maintenance of sinus rhythm after conversion from atrial fibrillation, evidence was strong for amiodarone, propafenone, disopyramide, and sotalol. Echocardiography was found to be useful in estimating risk for thromboembolism and potentially useful in estimating likelihood of successful cardioversion and maintenance.
For several key questions in the pharmacologic management of atrial fibrillation, strong evidence exists to support 1 or more treatment options.
本综述总结了有关用于控制心室率、预防中风、急性转复和维持窦性心律的药物疗效的现有证据，以及电复律的疗效和超声心动图在房颤患者中的应用。
Cochrane协作网的对照临床试验数据库和MEDLINE。
主要为药物的随机对照试验。
由配对的评审员获取疗效和安全性数据。评估证据强度。
近期临床试验结果表明，与恢复窦性心律的策略相比，大多数房颤患者采用控制心室率的策略有相似的结局。对于一级预防中风的疗效，与安慰剂相比，华法林的证据充分，阿司匹林的证据提示有效。华法林导致大出血风险增加的证据提示存在，阿司匹林的证据尚无定论。对于心室率控制，维拉帕米、地尔硫䓬、阿替洛尔和美托洛尔在质量上优于地高辛和安慰剂，尤其是在运动期间。对于急性转复的疗效，与安慰剂相比，伊布利特、氟卡尼、多非利特、普罗帕酮、胺碘酮和奎尼丁的证据充分。对于房颤转复后维持窦性心律的疗效，胺碘酮、普罗帕酮、丙吡胺和索他洛尔的证据充分。发现超声心动图有助于估计血栓栓塞风险，可能有助于估计成功复律和维持的可能性。
对于房颤药物治疗中的几个关键问题，有充分的证据支持一种或多种治疗选择。
