Costeas C, Kassotis J, Blitzer M, Reiffel J A
Department of Medicine, Columbia University, New York, New York, USA.
Pacing Clin Electrophysiol. 1998 Apr;21(4 Pt 1):742-52. doi: 10.1111/j.1540-8159.1998.tb00132.x.
Atrial fibrillation (AF) is the most common, sustained, symptomatic tachyarrhythmia that clinicians are called upon to manage. Management strategies include ventricular rate control coupled with anticoagulation, versus restoration and maintenance of sinus rhythm. Rate control may be achieved pharmacologically, with agents that impair AV nodal conduction directly and/or by increasing parasympathetic/sympathetic balance, or by modifying or ablating the AV nodal region anatomically. Rhythm control may be achieved by electrical or pharmacological conversion followed by maintenance of sinus rhythm by pharmacological (or occasionally ablative) therapies. This article will present current approaches to rate and rhythm control issues in AF. Part 1, published previously, dealt with rate control. Part 2, the current article, details approaches to the restoration of sinus rhythm by electrical and pharmacological means. The former may use transthoracic or catheter-based energy delivery systems. The latter may use intravenous or oral drug approaches. Part 3, to be published in a subsequent edition of PACE will deal with the maintenance of sinus rhythm.
心房颤动（AF）是临床医生需要处理的最常见的持续性症状性快速心律失常。治疗策略包括心室率控制联合抗凝治疗，以及恢复并维持窦性心律。心率控制可通过药物实现，使用直接损害房室结传导和/或通过增加副交感神经/交感神经平衡的药物，或通过解剖学上改变或消融房室结区域来实现。节律控制可通过电复律或药物复律，随后通过药物（或偶尔通过消融）治疗维持窦性心律来实现。本文将介绍当前房颤心率和节律控制问题的处理方法。之前发表的第1部分讨论了心率控制。第2部分，即本文，详细介绍了通过电和药物手段恢复窦性心律的方法。前者可使用经胸或基于导管的能量传递系统。后者可使用静脉或口服药物方法。第3部分将在《PACE》的后续版本中发表，将讨论窦性心律的维持。
