Calò Leonardo, Martino Annamaria, Sciarra Luigi, Ciccaglioni Antonio, De Ruvo Ermenegildo, De Luca Lucia, Sette Antonella, Giunta Giuseppe, Lioy Ernesto, Fedele Francesco
Division of Cardiology, Policlinico Casilino ASL RMB, Rome, Italy.
Pacing Clin Electrophysiol. 2011 Jan;34(1):111-28. doi: 10.1111/j.1540-8159.2010.02942.x. Epub 2010 Oct 28.
Atrial fibrillation is the most common arrhythmia in clinical practice. Ion channel blocking agents are often characterized by limited long-term efficacy and several side effects. In addition, ablative invasive procedures are neither easily accessible nor always efficacious. The "upstream therapy," which includes angiotensin-converting enzyme inhibitors, aldosterone receptor antagonists, statins, glucocorticoids, and ω-3 poly-unsaturated fatty acids, targets arrhythmia substrate, influencing atrial structural and electrical remodeling that play an essential role in atrial fibrillation induction and maintenance. The mechanisms involved and the most important clinical evidence regarding the upstream therapy influence on atrial fibrillation are presented in this review. Some open questions are also proposed.
心房颤动是临床实践中最常见的心律失常。离子通道阻滞剂的特点往往是长期疗效有限且有多种副作用。此外，消融性侵入性手术既不易实施，也并非总能奏效。“上游治疗”包括血管紧张素转换酶抑制剂、醛固酮受体拮抗剂、他汀类药物、糖皮质激素和ω-3多不饱和脂肪酸，其针对心律失常基质，影响在心房颤动的诱发和维持中起重要作用的心房结构和电重构。本文综述了上游治疗影响心房颤动的相关机制及最重要的临床证据。同时也提出了一些尚未解决的问题。
