Johnson David L, Day John D, Mahapatra Srijoy, Bunch T Jared
Intermountain Heart Rhythm Specialists, Intermountain Medical Center, Murray Utah.
St. Jude Medical Corporation.
J Atr Fibrillation. 2012 Feb 2;4(5):477. doi: 10.4022/jafib.477. eCollection 2012 Feb-Mar.
Atrial Fibrillation (AF) continues to increase in prevalence and its' consequences and disease associations have a great impact on multiple aspects of medical practice. As such, making preventive strategies to minimize risk of the arrhythmia and its' complications are paramount to improve quality of life, mortality, and limit medical resource utilization. To the extent that AF independently impacts adverse cardiovascular outcomes, this review article will focus on these outcomes, in particular heart failure (HF), stroke, and mortality, and discuss contemporary strategies for treatment. AF has a marked deleterious impact on the lives of patients. This impact can be accelerated when other cardiac diseases coexist. Although rhythm control strategies have been an intriguing tool to reverse or minimize the adverse outcomes associate with AF, they have largely been unsuccessful. In general, failures of currently available AADs to improve survival are due to failure of the drug to maintain sinus rhythm and presence of drug toxicities. Early data with ablation approaches are favorable and support rhythm control strategies to minimize long-term risks associated with AF. However, most of the data stem from observational analysis or small randomized trials. Large randomized prospective trials will ultimately define the role of catheter ablation in the management of AF patients.
心房颤动(AF)的患病率持续上升,其后果及与疾病的关联对医疗实践的多个方面产生重大影响。因此,制定预防策略以降低心律失常及其并发症的风险对于提高生活质量、降低死亡率以及限制医疗资源利用至关重要。鉴于AF独立影响不良心血管结局,本文将聚焦于这些结局,特别是心力衰竭(HF)、中风和死亡率,并讨论当代治疗策略。AF对患者的生活有显著的有害影响。当其他心脏疾病并存时,这种影响会加剧。尽管节律控制策略一直是逆转或最小化与AF相关不良结局的有趣工具,但它们在很大程度上并不成功。一般来说,目前可用的抗心律失常药物(AADs)未能改善生存率是由于药物无法维持窦性心律以及存在药物毒性。消融方法的早期数据是有利的,并支持节律控制策略以最小化与AF相关的长期风险。然而,大多数数据来自观察性分析或小型随机试验。大型随机前瞻性试验最终将确定导管消融在AF患者管理中的作用。