Stafford R S, Robson D C, Misra B, Ruskin J, Singer D E
General Medicine Division, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
Arch Intern Med. 1998 Oct 26;158(19):2144-8. doi: 10.1001/archinte.158.19.2144.
Little is known about national patterns of pharmacological treatment of atrial fibrillation, in particular, use of medications for ventricular rate control and for restoration and maintenance of sinus rhythm.
We analyzed 1555 visits by patients with atrial fibrillation to randomly selected office-based US physicians included in National Ambulatory Medical Care surveys conducted in 1980, 1981, 1985, and 1989 through 1996. To determine national trends, we evaluated the proportion of atrial fibrillation visits with reported use of rate control medications (digoxin and antiarrhythmics in classes II and IV) and sinus rhythm medications (classes IA, IC, and III).
The use of rate control agents decreased from 79% of atrial fibrillation visits in 1980-1981 to 62% in 1994-1996. Declining use was noted for both digoxin (76% in 1980-1981 to 53% in 1994-1996) and beta-blockers (19%-13%). After their introduction, the use of verapamil hydrochloride and diltiazem hydrochloride increased to 15% of atrial fibrillation visits in 1994-1996. Sinus rhythm agent use decreased from 18% of visits in 1980-1981 to 4% in 1992-1993 and then rose to 13% in 1994-1996. The use of class IA agents declined from 18% in 1980-1981 to 3.5% in 1992-1993 and then increased to 8% in 1994-1996. Quinidine remained the most widely used sinus rhythm medication, despite its declining share of this category. Newly available sotalol hydrochloride and amiodarone hydrochloride were used in 3.6% of visits in 1994-1996.
Despite changes in the treatment of atrial fibrillation, digoxin remains the dominant rate control medication. Medications for sinus rhythm maintenance are not widely used. Quinidine use declined prominently in the 1980s, possibly because of concerns about proarrhythmic effects. The use of sinus rhythm agents, however, is now rising.
关于心房颤动的全国药物治疗模式，尤其是用于控制心室率以及恢复和维持窦性心律的药物使用情况，人们了解甚少。
我们分析了1980年、1981年、1985年以及1989年至1996年期间纳入美国国家门诊医疗调查的随机选取的基层医生处就诊的1555例心房颤动患者。为确定全国趋势，我们评估了报告使用心率控制药物（地高辛以及II类和IV类抗心律失常药物）和窦性心律药物（IA类、IC类和III类）的心房颤动就诊比例。
心率控制药物的使用从1980 - 1981年心房颤动就诊患者的79%降至1994 - 1996年的62%。地高辛（从1980 - 1981年的76%降至1994 - 1996年的53%）和β受体阻滞剂（从19%降至13%）的使用均呈下降趋势。盐酸维拉帕米和盐酸地尔硫䓬引入后，其使用在1994 - 1996年增至心房颤动就诊患者的15%。窦性心律药物的使用从1980 - 1981年就诊患者的18%降至1992 - 1993年的4%，然后在1994 - 1996年升至13%。IA类药物的使用从1980 - 1981年的18%降至1992 - 1993年的3.5%，然后在1994 - 1996年增至8%。尽管奎尼丁在该类别中的份额不断下降，但它仍是使用最广泛的窦性心律药物。1994 - 1996年，新上市的盐酸索他洛尔和盐酸胺碘酮在3.6%的就诊中被使用。
尽管心房颤动的治疗有所变化，但地高辛仍是主要的心率控制药物。用于维持窦性心律的药物未得到广泛使用。奎尼丁的使用在20世纪80年代显著下降，可能是由于对促心律失常作用的担忧。然而，目前窦性心律药物的使用正在增加。
