Tadros Rafik, Khairy Paul, Rouleau Jean L, Talajic Mario, Guerra Peter G, Roy Denis
Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000 Belanger St. E, Montreal, QC, H1T 1C8, Canada.
Heart Fail Rev. 2014 May;19(3):315-24. doi: 10.1007/s10741-013-9395-6.
Pharmacological treatment of atrial fibrillation in the context of heart failure poses numerous challenges. Management decisions are limited by contraindications to several drugs and the paucity of robust clinical trials that provide evidence-based guidance. This review proposes a structured action plan for managing atrial fibrillation coexisting with heart failure that considers published clinical guidelines and integrates recent data derived from substudies of randomized trials, including the atrial fibrillation and congestive heart failure (AF-CHF) trial. Areas of uncertainty, such as target heart rates in atrial fibrillation and upstream therapies, are also discussed.
在心力衰竭背景下，心房颤动的药物治疗面临诸多挑战。管理决策受到多种药物禁忌证的限制，且缺乏能提供循证指导的有力临床试验。本综述提出了一项针对合并心力衰竭的心房颤动的结构化行动计划，该计划考虑了已发表的临床指南，并整合了来自随机试验亚研究的最新数据，包括心房颤动与充血性心力衰竭（AF-CHF）试验的数据。文中还讨论了一些存在不确定性的领域，如心房颤动的目标心率及上游治疗。
