Kühlkamp Volker, Bosch Ralph, Mewis Christian, Seipel Ludger
Medizinische Klinik III der Eberhard-Karls-Universität Tübingen, Tuebingen, Germany.
Am J Cardiovasc Drugs. 2002;2(1):37-42. doi: 10.2165/00129784-200202010-00005.
Atrial fibrillation is the most common arrhythmia in the general population and is frequently associated with organic heart disease. beta-adrenoceptor antagonists (b-blockers) are very effective in preventing atrial fibrillation after coronary artery bypass surgery. It has been shown recently that the beta-blocker metoprolol controlled release/extended release (CR/XL) is also effective in maintaining sinus rhythm after conversion of atrial fibrillation. There is concern that class I antiarrhythmic drugs, such as quinidine, disopyramide, and flecainide in particular, may increase mortality. The risk of proarrhythmia associated with beta-blocker treatment is very low. Therefore b-blockers, such as metoprolol CR/XL, may be the first line of treatment to maintain sinus rhythm, especially after myocardial infarction and in patients with chronic heart failure and in those with arterial hypertension. In patients with persistent atrial fibrillation, AV-nodal conduction-slowing drugs, such as calcium channel antagonists and beta-blockers are used to control the ventricular rate during atrial fibrillation. Several studies clearly show that beta-blockers alone, or in combination with digoxin are very effective in controlling the ventricular rate at rest and during exercise. beta-blockers are effective in maintaining sinus rhythm and controlling the ventricular rate during atrial fibrillation. Given these effects and their favorable effects on mortality, beta-blockers should be considered as first-line agents in the management of patients with atrial fibrillation.
心房颤动是普通人群中最常见的心律失常，且常与器质性心脏病相关。β肾上腺素能受体拮抗剂（β受体阻滞剂）在预防冠状动脉搭桥手术后的心房颤动方面非常有效。最近有研究表明，β受体阻滞剂美托洛尔控释/缓释片（CR/XL）在心房颤动转复后维持窦性心律方面也有效。有人担心Ⅰ类抗心律失常药物，特别是奎尼丁、丙吡胺和氟卡尼，可能会增加死亡率。与β受体阻滞剂治疗相关的致心律失常风险非常低。因此，β受体阻滞剂，如美托洛尔CR/XL，可能是维持窦性心律的一线治疗药物，尤其是在心肌梗死后以及慢性心力衰竭患者和动脉高血压患者中。对于持续性心房颤动患者，房室结传导减慢药物，如钙通道拮抗剂和β受体阻滞剂，用于控制心房颤动期间的心室率。多项研究清楚地表明，单独使用β受体阻滞剂或与地高辛联合使用，在控制静息和运动时的心室率方面非常有效。β受体阻滞剂在维持窦性心律和控制心房颤动期间的心室率方面有效。鉴于这些作用及其对死亡率的有利影响，β受体阻滞剂应被视为心房颤动患者管理中的一线药物。
