Stevenson William G, Tedrow Usha B, Seiler Jens
The Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital,Harvard Medical School, Boston, Massachusetts.
J Atr Fibrillation. 2008 Jul 16;1(2):101. doi: 10.4022/jafib.101. eCollection 2008 Jul-Aug.
Atrial fibrillation is common in heart failure patients and is associated with increased mortality. Pharmacologic trials have not shown any survival benefit for a rhythm control over a rate control strategy. It has been suggested that sinus rhythm is associated with a survival benefit, but that the risks of anti-arrhythmic drug treatment and poor efficacy offset the beneficial effect. Catheter ablation for atrial fibrillation can establish sinus rhythm without the risks of anti-arrhythmic drug therapy. Data from randomized trials demonstrating a survival benefit for patients undergoing an ablation procedure for atrial fibrillation are still lacking. Ablation of the AV junction and permanent pacing remain a treatment alternative in otherwise refractory cases. Placement of a biventricular system may prevent or reduce negative consequences of chronic right ventricular pacing. Current objectives and options for treatment of atrial fibrillation in heart failure patients are reviewed.
心房颤动在心力衰竭患者中很常见，且与死亡率增加相关。药物试验并未显示节律控制策略优于心率控制策略能带来任何生存获益。有人提出窦性心律与生存获益相关，但抗心律失常药物治疗的风险和疗效不佳抵消了其有益效果。房颤导管消融可建立窦性心律，而无抗心律失常药物治疗的风险。目前仍缺乏来自随机试验的数据来证明房颤消融手术对患者有生存获益。在其他难治性病例中，房室结消融和永久起搏仍是一种治疗选择。双心室系统的植入可能预防或减少慢性右心室起搏的负面影响。本文综述了目前心力衰竭患者房颤治疗的目标和选择。
