Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Cardiol Rev. 2010 Jan-Feb;18(1):38-50. doi: 10.1097/CRD.0b013e3181c21cff.
Atrial fibrillation (AF) and heart failure (HF) are common and interrelated conditions, each promoting the other, and both associated with increased mortality. HF leads to structural and electrical atrial remodeling, thus creating the basis for the development and perpetuation of AF; and AF may lead to hemodynamic deterioration and the development of tachycardia-mediated cardiomyopathy. Stroke prevention by antithrombotic therapy is crucial in patients with AF and HF. Of the 2 principal therapeutic strategies to treat AF, rate control and rhythm control, neither has been shown to be superior to the other in terms of survival, despite better survival in patients with sinus rhythm compared with those in AF. Antiarrhythmic drug toxicity and poor efficacy are concerns. Catheter ablation of AF can establish sinus rhythm without the risks of antiarrhythmic drug therapy, but has important procedural risks, and data from randomized trials showing a survival benefit of this treatment strategy are still lacking. In intractable cases, ablation of the atrioventricular junction and placement of a permanent pacemaker is a treatment alternative; and biventricular pacing may prevent or reduce the negative consequences of chronic right ventricular pacing.
心房颤动（AF）和心力衰竭（HF）是常见且相互关联的病症，两者相互促进，并且都与死亡率增加有关。HF 导致心房的结构和电重构，从而为 AF 的发展和持续提供了基础；而 AF 可能导致血液动力学恶化和心动过速性心肌病的发展。在 AF 和 HF 患者中，通过抗血栓治疗预防中风至关重要。在治疗 AF 的 2 种主要治疗策略中，尽管与 AF 相比窦性心律患者的生存率更高，但在生存率方面，控制心率和控制节律均未显示优于另一种策略。抗心律失常药物的毒性和疗效不佳是令人担忧的问题。AF 的导管消融可以建立窦性心律，而没有抗心律失常药物治疗的风险，但具有重要的程序风险，并且缺乏显示这种治疗策略具有生存获益的随机试验数据。在难治性病例中，房室结消融和永久性起搏器的放置是一种替代治疗方法；双心室起搏可能预防或减少慢性右心室起搏的负面后果。
