心房颤动患者的心律与心率控制及临床决策

心房颤动（房颤）是最常见的持续性快速心律失常。心律控制和心率控制是治疗房颤的两大基本策略。房颤的心律控制包括药物和电复律及介入治疗。心律控制理论上比单纯心率控制更有优势,部分研究也表明心律控制在改善某些患者的预后方面优于心率控制,特别是心率快合并心律失常性心肌病的情况下。除了心律控制,在有些情况下,可以将心率控制作为长期治疗方案。对存在动脉栓塞危险的患者,应进行抗凝治疗。     

心房颤动的维持窦性心律药物选择

维持心房颤动(房颤)患者窦性心律的抗心律失常药物有几种。当选用抗心律失常药物维持窦性心律时,应考虑以下几个问题:是否应该应用抗心律失常药物?首选哪种药物,应避免选用哪种药物?怎样判断是否有效?怎样减少不良反应?1应用抗心律失常药物的意义房颤心律控制和室率控制对比的几项临床试验表明,应用抗心律失常药物维持窦性心律并不能改善患者的存活率。直到近几年我们才认识到,应用药物维持窦性心律并不能改善房颤患者的生存率,也不能减少血栓栓塞事件等并发症,选择应用抗心律失常药物的意义仅在于减轻部分患者与房颤相关的症状,特别是在充…     

顿服负荷量心律平转复阵发性心房颤动

心房颤动 (房颤 )是临床最常见的心律失常之一。房颤发作时引发了血流动力学改变 ,即丧失了房室同步性 ,心功能损害、心排量降低及中风事件发生率增高 ,房颤患者生活质量明显下降。因此 ,阵发性房颤发生后 ,尽快复转十分重要 ,不仅能够尽早消除上述种种危害 ,而且可减少房颤的连缀现象[1] 。本文报告一组顿服负荷量心律平转复阵发性房颤 ,与其未服药前相对比来判心律平的疗效及安全性。资料与方法1　病例选择　 1 6例急诊患者 ,有心悸症状 ,经问诊、体检、心电图、超声心动图检查及既往在我院住院病史诊断为反复发作性阵发性房颤 ,左房内径 …     

心房颤动治疗策略——是否转复窦性心律

心房颤动是临床中最常见的慢性心律失常,其发生率随年龄的增长而明显增加,60岁以上人群的发病率为4％,80岁以上高达20％。房颤也是最常见的需要用药物控制症状的心律失常。临床医生往往认为房颤的治疗较为简单,即首先力争转复并维持窦性心律,不然则控制房颤的心室率。ACC/AHA发表的最新房颤指南认为,心房颤动的治疗主要包括心律失常本身的治疗和预防血栓栓塞两大方面。指南中关于血栓栓塞的研究信息十分丰富并且证据水平较高,而对心律失常的治疗则主张应针对不同类型的房颤,选择不同的治疗策略。症状轻微、新发生的阵发性房颤,可能不需要任何治疗。慢性永久性房颤控制心室率即可,而对持续性房颤的患者,     

顿服心律平转复心房颤动的临床观察

目的 探讨和验证顿服600mg心律平转复近期心房颤动的有效性及安全性.方法 选择近期(2h<持续时间<7d)发生房颤的患者60例,无禁忌症,随机分为2组;口服组给予心律平片600mg顿服;静脉组给予心律平针剂70mg静推,无效后30min重复该剂量给药.用药期间及用药后监护心电及房颤转复情况.结果 口服组30例,1h转复2例(6.7%),3h转复16例(53.3%),8h转复23例(76.7%).静脉组30例,1h转复7例(23.3%),3h转复15例(43.3%).8h转复22例(73.3%).两组比较,差异无统计学意义(P>0.05).口服组未发生明显不良反应,静脉级1例转复后一过性严重窦缓,1例发生一过性Ⅲ度房室传导阴滞.结论 顿服心律片与静脉推注心律平针剂转复近期房颤疗效相同,但大剂量口服用药比大剂量静脉用药更安全.     

超小剂量胺碘酮对心房颤动转律后维持窦性心律的疗效

心房颤动(房颤)是常见心律失常，巳证明小剂量胺碘酮对房颤转律后维持窦律的有效性。Mahmarlan等证明了胺碘酮控制非持续性室速最低有效剂量为lOOmg且未见不良反应．本意在探讨超小剂量胺碘硐[IOOmg／d]在房颤转律后维持窦律的有效性和安全性。     

PBMV术后房颤患者控制心律和心率的临床评价

目的:评价风湿性心脏病二尖瓣狭窄合并心房颤动在PBMV术后控制心律和心率对患者预后的影响。方法:选择风湿性心脏病二尖瓣狭窄合并房颤PBMV术后的患者347例为观察对象,分为控制心律组164例,其中男68例,女96例,年龄17~58岁,平均37.7±9.8岁,房颤病史6个月~11年,平均5.9±3.7年,直流电转复心律,采用100~300J,平均158.6±36.8J的能量,应用口服胺碘酮维持窦性心律;控制心率组183例,其中男72例,女111例,年龄18~64岁,平均39.2±11.3岁,房颤病史6个月-12年,平均6.2±3.9年,应用口服地高辛,β-阻滞剂或钙拮抗剂控制心率,华法令持续抗凝。观察两组间再住院率、不良事件发生率的差别。结果:心律控制组有56例病人在随访期间再住院1~2次,平均1.2±0.4次,再住院率为34.1%,有1例死亡,8例出现脑栓塞,不良事件发生5.5%,口服胺腆酮未出现药物毒副反应。心率控制组有108例再次住院,住院次数1~3次,平均1.6±0.9次,再住院率为59.0%,有2例死亡,28例出现脑栓塞,3例出现下肢栓塞,1例出现肠系膜上动脉栓塞,不良事件发生率18.6%,服药期间有67例出现轻度的出血症状,二组在再住院率方面比较P<0.05,有显著性差异,不良事件发生率二者比较P<0.01,有非常显著性差异。结论:对于风湿性心脏病二尖瓣狭窄合并房颤在PBMV术后控制心律比控制心率在病人再住院率、不良事件发生率方面具有明显优越性,更好地改善病人的预后。     

持续性心房颤动的心率变异性分析

目的分析和评价持续性心房颤动患者心率变异性指标的变化并探讨其中自主神经活动的变化规律。方法在动态心电图的基础上测量分析32例持续性心房颤动患者的心率变异性指标（SDNN；SDANN；RMSSD和HRV三角指数）的改变。结果32例患者的长程心率变异性指标均表现出一定的特异性改变和昼夜分布规律。结论持续性心房颤动患者存在着明显的自主神经功能失常，心率变异性分析有助于对病情的诊断。     

Atrial fibrillation

Atrial fibrillation is the most common arrhythmia affecting patients today. Disease prevalence is increasing at an alarming rate worldwide, and is associated with often catastrophic and costly consequences, including heart failure, syncope, dementia, and stroke. Therapies including anticoagulants, anti-arrhythmic medications, devices, and non-pharmacologic procedures in the last 30 years have improved patients＂ functionality with the disease. Nonetheless, it remains imperative that further research into AF epidemiology, genetics, detection, and treatments continues to push forward rapidly as the worldwide population ages dramatically over the next 20 years.     

Atrial fibrillation

The incidence and prevalence of atrial fibrillation are increasing because of both population ageing and an age-adjusted increase in incidence of atrial fibrillation. Deciding between a rate control or rhythm control approach depends on patient age and comorbidities, symptoms and haemodynamic consequences of the arrhythmia, but either approach is acceptable. Digoxin is no longer a first-line drug for rate control: beta-blockers and verapamil and diltiazem control heart rate better during exercise. Anti-arrhythmic drugs have only a 40%-60% success rate of maintaining sinus rhythm at 1 year, and have significant side effects. The selection of optimal antithrombotic prophylaxis depends on the patient's risk of ischaemic stroke and the benefits and risks of long-term warfarin versus aspirin, but is independent of rate or rhythm control strategy. Ischaemic stroke risk is best estimated with the CHADS2 score (Congestive heart failure, Hypertension, Age > or = 75 years, Diabetes, 1 point each; prior Stroke or transient ischaemic attack, 2 points). For patients with valvular atrial fibrillation or a CHADS(2) score > or = 2, anticoagulation with warfarin is recommended (INR 2-3, higher for mechanical valves) unless contraindicated or annual major bleeding risk > 3%. Aspirin or warfarin may be used when the CHADS(2) score = 1. Aspirin, 81-325 mg daily, is recommended in patients with a CHADS(2) score of 0 or if warfarin is contraindicated. Stroke rate is similar for paroxysmal, persistent, and permanent atrial fibrillation, and probably for atrial flutter.     

Atrial fibrillation: new horizons

Atrial fibrillation (AF) is the most common cardiac arrhythmia seen in clinical practice. The understanding of the pathophysiology of AF has changed drastically during the last several decades. Recent observations have challenged the concept of the multiple circuit reentry model in favor of single focus or single circuit reentry models. Atrial electrical dysfunction provides a favorable substrate and transmembrane ionic currents are key determinants. Interest has also been generated in the role of angiotensin converting enzyme (ACE) inhibition in reversing the electrical and structural remodeling. Reverting to the sinus rhythm seems to be the best way for reverse remodeling of atria during atrial fibrillation. Antiarrhythmic drugs (AADs) are only modestly effective. Of these amiodarone seems to provide the most benefits. Drugs like verapamil and ACE inhibitors may also help as adjuvant therapies in the reverse remodeling of atria. Nonpharmacological methods have been used to control both rate and rhythm for patients with AF. Recently, there has been a surge in interest to focal ablation of atrial foci. Focal sources of AF are commonly found in pulmonary veins (PV). Ablation in pulmonary veins through identification of the earliest endocardial activation has met with variable success. Anatomical approaches have involved circumferential radiofrequency ablation of pulmonary vein ostia using novel techniques such as balloon based circumferential ultrasound ablation system and circular cryoablation catheter. Most recently the segmental approach is preferred because the myocardial fibers surrounding the PV are not continuous. Segments where musculature is present can be identified using high frequency depolarization signals recorded through multi-electrode loop catheter or even conventional catheters.     

Mechanisms of disease: Atrial fibrillation

ATRIAL FIBRILLATION (AF) is the most common sustained dysrhythmia in adults. It is ironic, then, that although mechanisms and effective treatments for most other supraventricular tachyarrhythmias have been discovered, AF remains incompletely understood and poorly treated. Nonetheless, our understanding of the pathophysiology of AF has improved in the last half-century, including some groundbreaking observations made in the last 10 years. Indeed, for some patients, the potential for cure now appears to be available. Because no unifying mechanism of AF has been proven, the aim of this review is to describe some of the common and important concepts behind current mechanistic theories of AF and how they contribute to our clinical understanding of AF.     

Atrial fibrillation: the questions and controversies

Atrial fibrillation is one of the commonest arrhythmias. It was first recognized over 100 years ago. However, many aspects including its mechanism, the role of autonomic as well as structural influences, and appropriate management including prevention of embolic events and indications for cardioversion have continued to provide questions for clinicians. This article is not intended to be all-embracing but to deal with some of these more perplexing and controversial areas.     

Atrial fibrillation in Europe

Atrial fibrillation (AF) is the most frequent arrhythmia whose incidence increases with age.At present about 1％-2％ of the European population suffer from AF.Presumably about 25％ of the population between 40 and 50 years will develop AF in their life course and the prevalence of AF will increase by at least 2.5-fold in the next 50 years.Apart from the hemodynamic impact and an increased mortality rate,non-valvular AF is associated with an increased 5-7 fold risk for stroke caused by embolism originating from the left atrium (LA) and especially from the left atrial appendage (LAA) as compared to patients without AF.Overall 20％-25％ of all ischemic strokes are caused by cardiac embolism,about 50％ of them occur in patients with non-valvular AF.In addition most AF patients are symptomatic and complain about palpitations,tachycardia,dizziness,dyspnea,and reduced physical capacity.Hospitalization due to AF related symptoms and complications is common.Besides clinical aspects,AF will have an increasing socio-economic impact in the future.