Camm A John, Savelieva Irina
Division of Cardiac & Vascular Sciences, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK.
J Interv Card Electrophysiol. 2008 Oct;23(1):7-14. doi: 10.1007/s10840-008-9269-3. Epub 2008 Jun 4.
The prevalence of atrial fibrillation (AF) is forecast to rise to 2-5% of the general population by 2050. Of the two fundamental treatment strategies for AF management, rhythm control is the approach which is generally preferred for active, symptomatic, and/or younger patients, whereas rate control is all that is found necessary in the more elderly, sedentary, asymptomatic individual. In many cases, at neither extreme, there remains a genuine choice of therapy, and for those patients, antiarrhythmic strategies would be preferred if effective and safe antiarrhythmic medications were available. Many new antiarrhythmic agents exploiting new mechanisms of action or novel combinations of established antiarrhythmic activity are currently being investigated. Agents which selectively inhibit ion channels specifically involved in atrial repolarization, so-called atrial repolarization delaying agents, are widely acknowledged as potentially ideal antiarrhythmic treatments, as they will probably be both effective and safe, at the very least (free of pro-arrhythmic effects at the ventricular level). Modified analogues of traditional antiarrhythmic drugs with different combinations of ion channel and receptor blocking effects, novel mechanisms of action, and less complicated metabolic profiles are also under development. Completely innovative antiarrhythmic agents with new antiarrhythmic mechanisms, such as stretch receptor antagonism, sodium calcium exchanger blockade, late sodium channel inhibition, and gap junction modulation are also being explored. In addition, there is increasing evidence in support of the antiarrhythmic action of non-antiarrhythmic drugs. Treatments with statins, omega-3 fatty acids, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and aldosterone antagonists are all potentially valuable, over and above any effect related to the treatment of underlying heart disease.
预计到2050年，心房颤动（AF）在普通人群中的患病率将升至2%-5%。在房颤管理的两种基本治疗策略中，节律控制通常是活跃、有症状和/或较年轻患者更倾向的方法，而心率控制则是老年、久坐、无症状个体所需的全部治疗。在许多情况下，处于两种极端情况之间的患者仍有真正的治疗选择，对于这些患者，如果有有效且安全的抗心律失常药物，抗心律失常策略将是首选。目前正在研究许多利用新作用机制或已确立的抗心律失常活性的新组合的新型抗心律失常药物。选择性抑制专门参与心房复极的离子通道的药物，即所谓的心房复极延迟剂，被广泛认为是潜在的理想抗心律失常治疗药物，因为它们可能至少是有效且安全的（在心室水平无促心律失常作用）。具有不同离子通道和受体阻断作用组合、新作用机制和较简单代谢谱的传统抗心律失常药物的改良类似物也在研发中。具有新抗心律失常机制的完全创新的抗心律失常药物，如牵张受体拮抗、钠钙交换体阻断、晚钠通道抑制和缝隙连接调节也在探索中。此外，越来越多的证据支持非抗心律失常药物的抗心律失常作用。他汀类药物、ω-3脂肪酸、血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂和醛固酮拮抗剂的治疗都具有潜在价值，这超出了与治疗潜在心脏病相关的任何作用。
