Giardina E G
College of Physicians and Surgeons, the Cardiovascular Clinical Pharmacology Laboratory, and the Center for Women's Health, Columbia University, New York, New York, USA.
Am J Cardiol. 1997 Aug 28;80(4C):11D-18D; discussion 35D-39D. doi: 10.1016/s0002-9149(97)00580-8.
Atrial fibrillation is the most common sustained arrhythmia reported in the United States; an estimated 1-2 million Americans have chronic nonvalvular atrial fibrillation. This disorder is associated with a substantial risk of stroke. Several recent studies provide evidence that anticoagulation therapy is indicated for stroke prevention in patients with nonvalvular atrial fibrillation after recovery from a minor stroke. Clinical and echocardiographic criteria help to identify those patients who are at especially high risk for thromboembolic stroke and are candidates for carefully controlled anticoagulation. In an effort to reduce the possibility of thromboembolic events following either chemical or electrical cardioversion, the American College of Chest Physicians has recently prepared guidelines for the use of anticoagulation in the conversion of atrial fibrillation. The efficacy of antiarrhythmic drug therapy for cardioversion is often difficult to assess. Furthermore, it is associated with major risks, including heart failure and exacerbation of arrhythmia, and minor risks, including systemic intolerance. A new National Institutes of Health trial, Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM), will clarify the true risks and benefits of antiarrhythmic therapy for conversion of atrial fibrillation to sinus rhythm. Patients who cannot tolerate drug therapy may benefit from interruption of conduction in the bundle of His, followed by implantation of a permanent pacemaker, the use of radiofrequency energy ablation, or the implantation of an atrial defibrillator. Some patients may benefit from surgical procedures, such as left atrial isolation, the corridor operation, and the maze operation.
心房颤动是美国报告的最常见的持续性心律失常；据估计，有100万至200万美国人患有慢性非瓣膜性心房颤动。这种疾病与中风的重大风险相关。最近的几项研究提供了证据，表明对于轻度中风后康复的非瓣膜性心房颤动患者，抗凝治疗适用于预防中风。临床和超声心动图标准有助于识别那些血栓栓塞性中风风险特别高且是仔细控制抗凝治疗候选者的患者。为了降低化学或电复律后血栓栓塞事件的可能性，美国胸科医师学会最近制定了心房颤动转复时抗凝治疗的使用指南。抗心律失常药物治疗复律的疗效往往难以评估。此外，它还伴有重大风险，包括心力衰竭和心律失常加重，以及轻微风险，包括全身不耐受。美国国立卫生研究院的一项新试验，即心房颤动节律管理随访调查（AFFIRM），将阐明抗心律失常治疗使心房颤动转复为窦性心律的真正风险和益处。不能耐受药物治疗的患者可能受益于希氏束传导中断，随后植入永久性起搏器、使用射频能量消融或植入心房除颤器。一些患者可能受益于外科手术，如左心房隔离、通道手术和迷宫手术。
