心房颤动的抗心律失常药物治疗：指南是否在指导临床实践？
Antiarrhythmic drug therapy for atrial fibrillation: are the guidelines guiding clinical practice?
作者信息
Reiffel James A, Naccarelli Gerald V
机构信息
Columbia University Medical Center, 161 Fort Washington Ave., New York, NY 10032, USA.
出版信息
Clin Cardiol. 2006 Mar;29(3):97-102. doi: 10.1002/clc.4960290303.
Abstract
The AFFIRM study showed no clear survival advantage for a rhythm versus rate control strategy in patients with atrial fibrillation (AF). However, rhythm control with antiarrhythmic drugs (AADs) is appropriate in a large number of patients with AF. The American College of Cardiology/ American Heart Association/European Society of Cardiology AF management guidelines include a safety-based algorithm for selection of AAD therapy. Class 1C agents are recommended as first-line therapy in patients without or with minimal structural heart disease. However, market research and clinical study data indicate a growing use of class III agents (mainly amiodarone) despite long-term safety and tolerability concerns, suggesting that clinical practice does not adhere to current guidelines.
摘要
AFFIRM研究表明，在心房颤动（AF）患者中，节律控制策略与心率控制策略相比，并无明显的生存优势。然而，对于大量AF患者而言，使用抗心律失常药物（AAD）进行节律控制是合适的。美国心脏病学会/美国心脏协会/欧洲心脏病学会的AF管理指南包含了一种基于安全性的AAD治疗选择算法。对于无结构性心脏病或仅有轻微结构性心脏病的患者，推荐将1C类药物作为一线治疗药物。然而，市场研究和临床研究数据表明，尽管存在长期安全性和耐受性问题，但III类药物（主要是胺碘酮）的使用却越来越多，这表明临床实践并未遵循当前指南。
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