Stettin G D
Robert Wood Johnson Clinical Scholars Program, University of California, San Francisco, USA.
West J Med. 1995 Apr;162(4):331-9.
Nonvalvular atrial fibrillation is an increasingly common condition. It may cause disabling symptoms and is an important risk factor for stroke. The goals of treatment include the relief and prevention of rate- and rhythm-related symptoms and the prevention of stroke and systemic emboli. Three principal treatments should be considered: pharmacologic rate control, cardioversion and antiarrhythmic therapy to restore and maintain sinus rhythm, and prophylactic anticoagulation or antiplatelet therapy to reduce the risk of stroke. The risks and benefits of each of these therapies have been reviewed. Symptoms, if present, can often be managed safely with rate-directed therapy alone. Until issues regarding safety and long-term efficacy are resolved, cardioversion and antiarrhythmic therapy should be limited to those patients whose symptoms cannot otherwise be controlled. The benefits of warfarin anticoagulation for the primary and secondary prevention of stroke in nonvalvular atrial fibrillation have been demonstrated convincingly by several randomized clinical trials. These benefits must be weighed against the real risk of major hemorrhage. For patients at low risk of stroke, the use of aspirin may be an acceptable alternative to warfarin sodium therapy.
非瓣膜性心房颤动是一种日益常见的病症。它可能导致致残症状，并且是中风的重要危险因素。治疗目标包括缓解和预防与心率及节律相关的症状，以及预防中风和全身性栓塞。应考虑三种主要治疗方法：药物性心率控制、复律以及使用抗心律失常疗法恢复并维持窦性心律，还有预防性抗凝或抗血小板治疗以降低中风风险。已对这些疗法各自的风险和益处进行了综述。如有症状，通常仅通过心率导向治疗就能安全地进行处理。在安全性和长期疗效问题得到解决之前，复律和抗心律失常治疗应仅限于症状无法通过其他方式控制的患者。几项随机临床试验已令人信服地证明了华法林抗凝在非瓣膜性心房颤动中风一级和二级预防中的益处。这些益处必须与严重出血的实际风险相权衡。对于中风低风险患者，使用阿司匹林可能是华法林钠治疗的可接受替代方案。
