Kassotis J, Costeas C, Blitzer M, Reiffel J A
Department of Medicine, Columbia University, New York, New York, USA.
Pacing Clin Electrophysiol. 1998 May;21(5):1133-45. doi: 10.1111/j.1540-8159.1998.tb00160.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 pharmacologic conversion followed by maintenance of sinus rhythm by pharmacologic (or occasionally ablative) therapies. This article will present current approaches to rate and rhythm control issues in atrial fibrillation. Parts 1 and 2, published previously, dealt with rate control and with the restoration of sinus rhythm. Part 3, the current article, details the selection process of choosing a therapy to maintain sinus rhythm, including the likelihood of success, the risks of therapy, and individualization of therapy as dependent upon the nature of the structural heart disease present. It also discusses nonpharmacologic approaches that have been recently developed or are undergoing development. One suggested drug selection algorithm is provided.
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性心律失常。治疗策略包括心室率控制联合抗凝治疗，以及恢复和维持窦性心律。心率控制可通过药理学方法实现，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。本文将介绍心房颤动心率和节律控制问题的当前方法。之前发表的第1部分和第2部分分别讨论了心率控制和窦性心律的恢复。第3部分即本文，详细阐述了选择维持窦性心律治疗方法的过程，包括成功的可能性、治疗风险以及根据存在的结构性心脏病的性质进行个体化治疗。还讨论了最近开发或正在开发的非药物治疗方法。提供了一种建议的药物选择算法。
