Division of Cardiology, Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
J Cardiovasc Pharmacol Ther. 2010 Dec;15(4 Suppl):31S-5S. doi: 10.1177/1074248410377617.
In recent years, a major development in the treatment of atrial fibrillation (AF) is the use of catheter ablation, and a significant number of patients may benefit from this mode of therapy. On a global scale, it may not be feasible to deal with most patients solely on the basis of ablation. Therefore, it is likely that much of the therapy for AF will continue to rely on antiarrhythmic agents for maintaining sinus rhythm. For many years, amiodarone and sotalol have been the dominant antiarrhythmic agents, with amiodarone being the most effective antiarrhythmic in suppressing AF; however, amiodarone use is limited due to concerns of end-organ toxicity. Upstream therapies, such as statins, fish oil, angiotensin converting enzyme (ACE) inhibitors, and angiotensin receptor blockers may also provide additive efficacy to these and other membrane-active antiarrhythmics. In recent years, a number of new agents are being developed and the first successful congener of amiodarone, dronedarone, has been shown to be effective in controlling AF and reducing cardiovascular hospitalization. This paper explores the possibility of augmenting the extent of controlling AF by combining multiple potent antiarrhythmic agents old and new.
近年来，心房颤动（AF）治疗的一个主要进展是导管消融的应用，大量患者可能从中受益。在全球范围内，仅基于消融来处理大多数患者可能并不实际。因此，AF 的大部分治疗可能仍将依赖于维持窦性心律的抗心律失常药物。多年来，胺碘酮和索他洛尔一直是主要的抗心律失常药物，胺碘酮是抑制 AF 最有效的抗心律失常药物；然而，由于担心对终末器官的毒性，胺碘酮的使用受到限制。上游治疗药物，如他汀类药物、鱼油、血管紧张素转换酶（ACE）抑制剂和血管紧张素受体阻滞剂，也可能为这些和其他膜活性抗心律失常药物提供附加疗效。近年来，正在开发许多新的药物，胺碘酮的第一个成功同类物决奈达隆已被证明能有效控制 AF 并减少心血管住院。本文探讨了通过联合使用新旧强效抗心律失常药物来扩大控制 AF 范围的可能性。
