Fung Jeffrey W H, Yu Cheuk M, Kum Leo C C, Yip Gabriel W K, Sanderson John E
Division of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
Card Electrophysiol Rev. 2003 Sep;7(3):236-42. doi: 10.1023/B:CEPR.0000012390.43937.2c.
Heart failure is a serious disorder associated with substantial morbidity and mortality. Approximately 15-30% patients with systolic heart failure are in atrial fibrillation and the proportion increases with severity of heart failure. Patients with heart failure and atrial fibrillation have worse outcome than those in sinus rhythm. Beta-blockers, together with angiotensin-converting enzymes inhibitors, are the standard therapy in patients with chronic heart failure. Retrospective studies have suggested that despite the improvement in left ventricular systolic function after treatment with beta-blockers, the exercise capacity and symptoms in those heart failure patients with atrial fibrillation was not improved as much as those in sinus rhythm. Moreover, the use of bisoprolol in the Cardiac Insufficiency Bisoprolol Study II, unlike those in sinus rhythm, failed to produce any survival benefit in patients with poor systolic function and atrial fibrillation. It seems that those patients with heart failure and atrial fibrillation may have different response to beta-blocker therapy. Prospective trials to clarify the impact of beta-blocker therapy and the optimal therapeutic strategy in this high-risk group of patients are warranted.
心力衰竭是一种严重的疾病，与较高的发病率和死亡率相关。约15%-30%的收缩性心力衰竭患者合并心房颤动，且这一比例随心力衰竭严重程度的增加而升高。心力衰竭合并心房颤动的患者比窦性心律患者的预后更差。β受体阻滞剂与血管紧张素转换酶抑制剂联合使用，是慢性心力衰竭患者的标准治疗方法。回顾性研究表明，尽管β受体阻滞剂治疗后左心室收缩功能有所改善，但心力衰竭合并心房颤动患者的运动能力和症状改善程度不及窦性心律患者。此外，在心脏 insufficiency Bisoprolol研究II中，与窦性心律患者不同，比索洛尔在收缩功能较差且合并心房颤动的患者中未能产生任何生存获益。心力衰竭合并心房颤动的患者似乎对β受体阻滞剂治疗可能有不同反应。有必要进行前瞻性试验，以阐明β受体阻滞剂治疗对这一高危患者群体的影响以及最佳治疗策略。
