Department of Cardiology, University Hospital of South Manchester NHS Foundation Trust, Manchester M23 9LT, UK.
Department of Internal Medicine, University Hospital of Patras, 26504 Patras, Greece.
Medicina (Kaunas). 2022 May 30;58(6):743. doi: 10.3390/medicina58060743.
Atrial fibrillation (AF) and Heart failure (HF) constitute two frequently coexisting cardiovascular diseases, with a great volume of the scientific research referring to strategies and guidelines associated with the best management of patients suffering from either of the two or both of these entities. The common pathophysiological paths, the adverse outcomes, the hospitalization rates, and the mortality rates that occur from various reports and trials indicate that a targeted therapy to the common background of these cardiovascular conditions may reverse the progression of their interrelating development. Among other optimal treatments concerning the prevalence of both AF and HF, the introduction of rhythm and rate control strategies in the guidelines has underlined the importance of sinus rhythm and heart rate control in the prevention of deleterious complications. The use of these strategies in the clinical practice has led to a debate about the superiority of rhythm versus rate control. The current guidelines as well as the published randomized trials and studies have not proved that rhythm control is more beneficial than the rate control treatments in the terms of survival, all-cause mortality, hospitalization rates, and quality of life. Therefore, the current therapeutic strategy is based on the therapy guidelines and the clinical judgment and experience. The aim of this review was to elucidate the endpoints of pharmacologic randomized clinical trials and the clinical data of each antiarrhythmic or rate-limiting medication, so as to promote their effective, individualized, evidence-based clinical use.
心房颤动（AF）和心力衰竭（HF）构成了两种经常同时存在的心血管疾病，大量的科学研究涉及与这两种疾病或这两种疾病的最佳管理相关的策略和指南。来自各种报告和试验的共同病理生理途径、不良结局、住院率和死亡率表明，针对这些心血管疾病共同背景的靶向治疗可能会逆转其相互发展的进程。在针对 AF 和 HF 流行的其他最佳治疗方法中，指南中节律和率控制策略的引入强调了窦性节律和心率控制在预防有害并发症中的重要性。这些策略在临床实践中的应用导致了关于节律控制与率控制优越性的争论。目前的指南以及已发表的随机试验和研究并未证明节律控制在生存、全因死亡率、住院率和生活质量方面优于率控制治疗。因此，目前的治疗策略基于治疗指南以及临床判断和经验。本综述的目的是阐明药物随机临床试验的终点和每种抗心律失常或限速药物的临床数据，以促进其有效的、个体化的、基于证据的临床应用。
