Ahmad Kamran, Dorian Paul
Division of Cardiology, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada.
Curr Opin Cardiol. 2006 Mar;21(2):88-93. doi: 10.1097/01.hco.0000210303.33866.c7.
The aim of this article is to provide a perspective on rate control in atrial fibrillation which emphasizes patient wellbeing (exercise tolerance, symptoms, quality of life) over attempts to reduce resting or exercise heart rate to an arbitrary range.
Recent trials of rhythm versus rate control strategies of treatment in patients with atrial fibrillation suggest that rate control is a viable first line strategy in many patients. The adverse consequences of atrial fibrillation with rapid ventricular response are partly due to factors other than rate itself, such as irregularity of ventricular response, and variable changes in autonomic nervous system output. Digoxin, calcium channel blockers, and beta-blockers cause a similar reduction in resting heart rate. Beta blockers are the most potent at reducing exercise heart rate, followed by calcium channel blockers and digoxin. Exercise tolerance is occasionally improved by digoxin, sometimes improved by calcium channel blockers and not improved by (and sometimes decreased by) beta-blockers. Information about quality of life with different rate control regimens is sparse.
Rate control in atrial fibrillation provides important benefits to patients in terms of symptoms, quality of life and prevention of late consequences of uncontrolled rate (such as tachycardia induced cardiomyopathy). Restricting treatment objectives to achievement of a specific heart rate range on resting or exercise electrocardiogram may result in lack of patient benefit or worsened symptoms. Understanding the nuances of rate control when treating individual patients and interpreting existing evidence allows patients to experience the most benefit from this treatment strategy.
本文旨在提供一种关于房颤心率控制的观点，该观点强调患者的健康状况（运动耐量、症状、生活质量），而非试图将静息或运动心率降低到任意范围。
近期针对房颤患者治疗的节律控制与心率控制策略的试验表明，心率控制对许多患者而言是一种可行的一线策略。房颤伴快速心室反应的不良后果部分归因于心率本身以外的因素，如心室反应的不规则性以及自主神经系统输出的变化。地高辛、钙通道阻滞剂和β受体阻滞剂可使静息心率出现类似程度的降低。β受体阻滞剂在降低运动心率方面效果最为显著，其次是钙通道阻滞剂和地高辛。地高辛偶尔可改善运动耐量，钙通道阻滞剂有时可改善运动耐量，而β受体阻滞剂则不能改善（有时还会降低）运动耐量。关于不同心率控制方案对生活质量影响的信息较少。
房颤的心率控制在症状、生活质量以及预防心率控制不佳的晚期后果（如心动过速性心肌病）方面为患者带来了重要益处。将治疗目标局限于在静息或运动心电图上达到特定心率范围可能无法使患者获益，甚至会使症状恶化。在治疗个体患者时理解心率控制的细微差别并解读现有证据，可让患者从该治疗策略中获得最大益处。
