Simon H, Simon Demel K, Ritscher G, Turschner O, Brachmann J
Kardiopulmonales Zentrum, Klinikum Coburg, Ketschendorferstr. 33, 96450, Coburg, Deutschland.
Herzschrittmacherther Elektrophysiol. 2010 Dec;21(4):212-6. doi: 10.1007/s00399-010-0093-y.
Atrial fibrillation, which is associated with a worsening of congestive heart failure symptoms, an increased rate of stoke, and increased mortality, is still difficult to treat. New therapies must not only increase effectiveness, but also have to have an improved safety profile, in order to avoid sodium channel block in the ventricle of older patients with atrial fibrillation, and also prevent electrical and morphological remodeling. Dronedarone is less effective compared to amiodarone, but has a better side effect profile which leads to fewer discontinuations of treatment. The atrial ion channels are specifically blocked by a number of prospective antiarrhythmic substances. The most advanced is the testing of vernakalant (RSD1235), which primarily suppresses the I(Kur) current. Ranolazine is a new antianginal substance which influences the atrial ion channels and leads to a significant reduction of atrial and more specifically ventricular tachyarrhythmias. A number of other drugs are in development. They will lead to a better understanding of which form of atrial fibrillation can be best treated with which antiarrhythmic agent.
心房颤动与充血性心力衰竭症状恶化、中风发生率增加及死亡率上升相关，其治疗仍颇具难度。新疗法不仅须提高疗效，还得具备更优的安全性，以避免老年心房颤动患者心室中的钠通道阻滞，同时防止电重构和形态重构。与胺碘酮相比，决奈达隆疗效欠佳，但副作用较小，导致治疗中断的情况较少。多种潜在的抗心律失常物质可特异性阻断心房离子通道。其中进展最为领先的是维纳卡兰（RSD1235）的试验，它主要抑制I(Kur)电流。雷诺嗪是一种新型抗心绞痛药物，可影响心房离子通道，显著减少心房尤其是心室的快速性心律失常。还有多种其他药物正处于研发阶段。它们将有助于更深入地了解哪种类型的心房颤动采用哪种抗心律失常药物治疗效果最佳。
