Hindricks G, Kottkamp H, Willems S, Haverkamp W, Borggrefe M, Breithardt G
Medizinische Klinik und Poliklinik, Universitätsklinik Münster.
Z Kardiol. 1994;83 Suppl 5:87-96.
In many patients with paroxysmal or chronic atrial fibrillation, long-term antiarrhythmic drug therapy is performed to prevent recurrences of atrial fibrillation or to reduce the incidence of paroxysmal attacks of atrial fibrillation. The results of several studies on the efficacy of antiarrhythmic drugs in patients with paroxysmal atrial fibrillation have revealed that the incidence of recurrent attacks of atrial fibrillation can be reduced and the duration of arrhythmia free intervals can be prolonged by antiarrhythmic drug therapy. However, complete prevention of atrial fibrillation can be achieved only in a minority of patients. At present, there is no evidence that antiarrhythmic drug treatment of patients with paroxysmal atrial fibrillation might worsen the prognosis by an increase in cardiac mortality induced by antiarrhythmic drugs. In patients with chronic atrial fibrillation, the recurrence rate of the arrhythmia can be significantly reduced by antiarrhythmic drug therapy within the first year of treatment. However, there is evidence that antiarrhythmic drugs might worsen the prognosis when compared to patients with atrial fibrillation not treated with antiarrhythmic drugs. Accordingly, the indication for antiarrhythmic drug therapy to prevent recurrences in patients with chronic atrial fibrillation has to be made restrictively and should be largely based on the symptomatic status of the patients. Antiarrhythmic drug therapy seems to be indicated only in patients who are significantly symptomatic or compromised by the arrhythmia. In patients without or with only mild symptoms, medical therapy with the aim to slow the ventricular response with digitalis, calcium antagonists or betablocking agents seems to be more adequate. Currently, with respect to efficacy and safety, there is no antiarrhythmic drug that has been proved to be superior to others and that can thus be recommended as the drug of first choice for patients with paroxysmal or chronic atrial fibrillation to prevent recurrences. The choice of the optimal antiarrhythmic drug should be made by taking individual factors (e.g., etiology of the arrhythmia, patient compliance, liver and renal function of the patient, additional medical therapy) into account. Major problems during long-term antiarrhythmic drug therapy may arise in patients with pre-existing sinus node dysfunction or conduction disturbances of the atrioventricular node. In addition, the conversion of atrial fibrillation with relatively slow ventricular rates to the atrial flutter with fast ventricular rates that is occasionally observed during treatment with class I-antiarrhythmic drugs may complicate long-term therapy.(ABSTRACT TRUNCATED AT 400 WORDS)
在许多阵发性或慢性心房颤动患者中，进行长期抗心律失常药物治疗以预防心房颤动复发或降低心房颤动阵发性发作的发生率。几项关于抗心律失常药物对阵发性心房颤动患者疗效的研究结果表明，抗心律失常药物治疗可降低心房颤动复发发作的发生率，并延长无心律失常间期的时长。然而，只有少数患者能完全预防心房颤动。目前，没有证据表明对阵发性心房颤动患者进行抗心律失常药物治疗会因抗心律失常药物导致的心脏死亡率增加而使预后恶化。在慢性心房颤动患者中，抗心律失常药物治疗在治疗的第一年可显著降低心律失常的复发率。然而，有证据表明，与未接受抗心律失常药物治疗的心房颤动患者相比，抗心律失常药物可能会使预后恶化。因此，对于慢性心房颤动患者预防复发的抗心律失常药物治疗指征必须严格掌握，且应主要基于患者的症状状况。抗心律失常药物治疗似乎仅适用于有明显症状或因心律失常而身体状况不佳的患者。对于无症状或仅有轻微症状的患者，使用洋地黄、钙拮抗剂或β受体阻滞剂来减慢心室率的药物治疗似乎更为合适。目前，就疗效和安全性而言，没有一种抗心律失常药物被证明优于其他药物，因此不能推荐作为阵发性或慢性心房颤动患者预防复发的首选药物。最佳抗心律失常药物的选择应考虑个体因素（如心律失常的病因、患者依从性、患者的肝肾功能、其他药物治疗）。长期抗心律失常药物治疗期间的主要问题可能出现在已有窦房结功能障碍或房室结传导障碍的患者中。此外，在使用I类抗心律失常药物治疗期间偶尔观察到的心房颤动伴相对缓慢心室率转变为心房扑动伴快速心室率的情况，可能会使长期治疗复杂化。（摘要截选至400字）
