Lamaison D, Laureille B
Service de cardiologie, hôpital G. Montpied, Clermont-Ferrand.
Rev Prat. 1993 Jun 15;43(12):1523-31.
The treatment of chronic atrial fibrillation has 3 different objectives: the control of the ventricular rate, the attempts to restore sinus rhythm, and the prevention of arrhythmia recurrences. Digitalis compounds, beta-adrenergic antagonists and calcium-channel blocking agents can be used to achieve reduction of the ventricular response, in recent-onset arrhythmia with rapid heart rate, and for long-term rate control in patients who cannot be converted to sinus rhythm. In some of them, a combination of 2 of these drugs is needed to slow the ventricular rate, at rest and on exertion. Sinus rhythm can be restored by direct-current cardioversion or by using various regimens of amiodarone, a type III antiarrhythmic drug, given orally or intravenously. Cardioversion might also be accomplished by type IA and IC antiarrhythmic drugs, including quinidine, flecainide and propafenone. However, proarrhythmic effects and haemodynamic deterioration are a major concern with these compounds. On the other hand the best indication of type IA and IC antiarrhythmic drugs is the control of arrhythmia recurrences; beta-blocking agents are highly effective in patients with a high sympathetic tone or hypertrophic cardiomyopathy. Finally the widespread use of amiodarone should be limited by its non-cardiac toxicity. Whatever the drug employed in the treatment of atrial fibrillation, monitoring the inotropic effect of the drug and the effect on cardiac conduction is mandatory.
慢性房颤的治疗有3个不同目标：控制心室率、尝试恢复窦性心律以及预防心律失常复发。洋地黄类药物、β肾上腺素能拮抗剂和钙通道阻滞剂可用于降低心室反应，用于近期发作的快速心率心律失常，以及用于无法转为窦性心律患者的长期心率控制。在其中一些患者中，需要联合使用这两种药物中的两种，以在静息和运动时减慢心室率。窦性心律可通过直流电复律或使用各种口服或静脉给药的胺碘酮（一种III类抗心律失常药物）方案来恢复。复律也可通过IA类和IC类抗心律失常药物来完成，包括奎尼丁、氟卡尼和普罗帕酮。然而，这些化合物的促心律失常作用和血流动力学恶化是主要关注点。另一方面，IA类和IC类抗心律失常药物的最佳适应证是控制心律失常复发；β受体阻滞剂在交感神经张力高或肥厚型心肌病患者中非常有效。最后，胺碘酮的广泛使用应因其非心脏毒性而受到限制。无论使用何种药物治疗房颤时必须监测药物的变力作用和对心脏传导的影响。
