Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.
Basic, Preventive and Clinical Sciences Department, Transilvania University, Brasov, Romania; and.
Am J Ther. 2022;29(1):e18-e25. doi: 10.1097/MJT.0000000000001464.
Advances in drug therapy for atrial fibrillation (AF) have had a significant impact on the quality of life of a substantial majority of affected persons, which has contributed to a remarkable decrease in the frequency and severity of thromboembolic complications, hospitalizations, and mortality.
What are the milestones of the changes in the expert approach to the pharmacological management of AF in the past century?
To determine the changes in the experts' approach to the management of AF, as presented in a widely used textbook in the United States.
The chapters presenting the management of AF in the 26 editions of Cecil Textbook of Medicine published from 1927 through 2020.
AF was consistently described in Cecil Textbook of Medicine as the most common sustained arrhythmia in adults. The authors emphasized its thromboembolic complications and potential for hemodynamic deterioration. Rate control with digitalis and rhythm control with quinidine were the standard in 1927. The pharmacological advances have focused on atrioventricular nodal blocking for rate control, conversion to and maintenance of sinus rhythm, and preventive anticoagulation. The first new class of drugs for rate control was beta-adrenergic receptor blockers, starting with propranolol which was introduced in 1979, followed by the calcium channel blocker verapamil in 1988. Rhythm control with amiodarone, a potassium channel blocker, has been recommended since 2004, and the sodium channel blockers propafenone and flecainide became part of standard therapy in 2008. Anticoagulation with warfarin was recommended starting in 2000, followed by the introduction of direct thrombin inhibitor in 2012 and factor Xa inhibitors in 2016.
The pharmacological management of AF was unchanged for more than 50 years (1927-1979), a period during which the devastating effects of thromboembolic complications were not addressed. The major therapeutic advance is represented by preventive anticoagulation with the newer, safer, and more user-friendly direct thrombin and factor Xa inhibitors.
心房颤动 (AF) 的药物治疗进展极大地改善了绝大多数受影响患者的生活质量，显著降低了血栓栓塞并发症、住院和死亡率的发生频率和严重程度。
在过去的一个世纪里，专家在心房颤动药物治疗方法上的改变有哪些里程碑？
为了确定美国一本广泛使用的教科书中所呈现的专家在心房颤动管理方法上的改变。
1927 年至 2020 年出版的 26 版 Cecil 内科学中关于心房颤动管理的章节。
AF 在 Cecil 内科学中一直被描述为成人中最常见的持续性心律失常。作者强调了它的血栓栓塞并发症和潜在的血液动力学恶化风险。1927 年，使用洋地黄进行心率控制和使用奎尼丁进行节律控制是标准治疗方法。药物治疗的进展主要集中在房室结阻滞以控制心率、转复和维持窦性节律以及预防性抗凝。控制心率的第一种新型药物是β肾上腺素能受体阻滞剂，从 1979 年引入的普萘洛尔开始，随后是 1988 年引入的钙通道阻滞剂维拉帕米。自 2004 年以来，一直推荐使用钾通道阻滞剂胺碘酮进行节律控制，而钠通道阻滞剂普罗帕酮和氟卡尼也于 2008 年成为标准治疗方法的一部分。自 2000 年起开始推荐使用华法林抗凝，随后在 2012 年引入了直接凝血酶抑制剂，在 2016 年引入了因子 Xa 抑制剂。
AF 的药物治疗在 50 多年（1927-1979 年）内没有改变，在此期间，血栓栓塞并发症的破坏性影响没有得到解决。最新的、更安全、更易用的直接凝血酶和因子 Xa 抑制剂预防性抗凝是主要的治疗进展。
