Department of Cardiology, Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine, and Life Sciences, Maastricht University, PO Box 616, Maastricht 6200, The Netherlands.
Department of Cardiology, J. W. Goethe-Universität Frankfurt am Main, Frankfurt/Main, Germany.
Europace. 2021 Apr 10;23(23 Suppl 2):ii14-ii22. doi: 10.1093/europace/euaa426.
Atrial fibrillation (AF) remains a highly prevalent and troublesome cardiac arrhythmia, associated with substantial morbidity and mortality. Restoration and maintenance of sinus rhythm (rhythm-control therapy) is an important element of AF management in symptomatic patients. Despite significant advances and increasing importance of catheter ablation, antiarrhythmic drugs (AADs) remain a cornerstone of rhythm-control therapy. During the past 50 years, experimental and clinical research has greatly increased our understanding of AADs. As part of the special issue on paradigm shifts in AF, this review summarizes important milestones in AAD research that have shaped their current role in AF management, including (i) awareness of the proarrhythmic potential of AADs; (ii) increasing understanding of the pleiotropic effects of AADs; (iii) the development of dronedarone; and (iv) the search for AF-specific AADs. Finally, we discuss short- and long-term opportunities for better AF management through advances in AAD therapy, including personalization of AAD therapy based on individual AF mechanisms.
心房颤动（AF）仍然是一种高发且麻烦的心律失常，与大量的发病率和死亡率相关。在有症状的患者中，恢复和维持窦性节律（节律控制治疗）是 AF 管理的重要组成部分。尽管导管消融术有了显著的进步和重要性的增加，但抗心律失常药物（AADs）仍然是节律控制治疗的基石。在过去的 50 年中，实验和临床研究大大提高了我们对 AADs 的理解。作为 AF 治疗范式转变特刊的一部分，这篇综述总结了 AAD 研究中的重要里程碑，这些研究塑造了它们在 AF 管理中的当前作用，包括：（i）对 AAD 致心律失常潜力的认识；（ii）对 AAD 多效性作用的认识不断加深；（iii）多非利特的开发；以及（iv）寻找 AF 特异性 AADs。最后，我们讨论了通过 AAD 治疗的进步来更好地管理 AF 的短期和长期机会，包括基于个体 AF 机制的 AAD 治疗个体化。
