University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK.
Lancet. 2012 Feb 18;379(9816):648-61. doi: 10.1016/S0140-6736(11)61514-6. Epub 2011 Dec 11.
The management of atrial fibrillation has evolved greatly in the past few years, and many areas have had substantial advances or developments. Recognition of the limitations of aspirin and the availability of new oral anticoagulant drugs that overcome the inherent drawbacks associated with warfarin will enable widespread application of effective thromboprophylaxis with oral anticoagulants. The emphasis on stroke risk stratification has shifted towards identification of so-called truly low-risk patients with atrial fibrillation who do not need antithrombotic therapy, whereas oral anticoagulation therapy should be considered in patients with one or more risk factors for stroke. New antiarrhythmic drugs, such as dronedarone and vernakalant, have provided some additional opportunities for rhythm control in atrial fibrillation. However, the management of the disorder is increasingly driven by symptoms. The availability of non-pharmacological approaches, such as ablation, has allowed additional options for the management of atrial fibrillation in patients who are unsuitable for or intolerant of drug approaches.
在过去的几年中，心房颤动的管理有了很大的发展，许多领域都取得了实质性的进展或突破。认识到阿司匹林的局限性以及新型口服抗凝药物的出现克服了华法林固有的缺点，这将使口服抗凝药物的有效血栓预防得到广泛应用。对卒中风险分层的重视已转向识别所谓的真正低危房颤患者，这些患者无需抗血栓治疗，而对于有一个或多个卒中风险因素的患者则应考虑口服抗凝治疗。新型抗心律失常药物，如多非利特和决奈达隆，为房颤的节律控制提供了一些额外的机会。然而，该疾病的管理越来越受到症状的驱动。非药物治疗方法（如消融）的出现，为不适合或不耐受药物治疗的患者提供了治疗房颤的额外选择。
