Reiffel James A
Department of Medicine, Division of Cardiology, Electrophysiology Section, Columbia University Medical Center, New York, NY.
J Atr Fibrillation. 2008 May 16;1(1):21. doi: 10.4022/jafib.21. eCollection 2008 May-Jun.
Atrial fibrillation (AF) is the most common sustainedcardiac rhythm disturbance encountered by physicians. The management of AF isfocused on control of heart rate, correction of rhythm disturbance, andrisk-determined prophylaxis of thromboembolism. The goals of AF therapy are, aswith other serious disorders, to reduce mortality (if possible) and morbidity(improve quality of life, [QOL]). To this end, several large studies haveexamined rhythm-control versus rate-control strategies. Although a survivaladvantage to using rhythm control with currently available antiarrhythmic drugshas not been proven, neither has there been a significant excess risk versusrate control. Therefore, using our current therapies, the results have notsupported rate control or rhythm control as being a preferable first-linetherapy for AF as regards survival; importantly, neither do they disprove the hypothesis thatmaintenance of sinus rhythm is preferable to the continuation of AF,particularly if rate control fails to restore adequate QOL. Many post-hocanalyses and substudies have assessed QOL, functional status, and exercisetolerance, with the majority demonstrating important benefits associated withachievement of rhythm control. This review examines rate and rhythm controloptions, the clinical outcomes of several important AF trials, discusses thelimitations in applying the major morbidity/mortality findings to everydayclinical practice, and summarizes the lessons learned.
心房颤动（AF）是医生所遇到的最常见的持续性心律失常。AF的治疗重点在于控制心率、纠正节律紊乱以及根据风险进行血栓栓塞的预防。与其他严重疾病一样，AF治疗的目标是降低死亡率（如果可能的话）和发病率（改善生活质量，[QOL]）。为此，几项大型研究对节律控制与心率控制策略进行了研究。虽然使用目前可用的抗心律失常药物进行节律控制的生存优势尚未得到证实，但与心率控制相比也没有显著的额外风险。因此，就生存而言，使用我们目前的治疗方法，结果既不支持心率控制也不支持节律控制作为AF的首选一线治疗方法；重要的是，它们也没有反驳窦性心律维持优于房颤持续的假设，特别是当心率控制未能恢复足够的生活质量时。许多事后分析和子研究评估了生活质量、功能状态和运动耐量，大多数研究表明实现节律控制有重要益处。本综述探讨了心率和节律控制选项、几项重要AF试验的临床结果，讨论了将主要发病率/死亡率研究结果应用于日常临床实践的局限性，并总结了经验教训。
