及早节律干预——刻不容缓

The Rationale of Early Rhythm Intervention for Atrial Fibrillation Patients

心房颤动(房颤)是临床上最常见的心律失常。房颤的治疗在当下仍是一大挑战。研究显示,长时间的心动过速会导致心肌结构重构,电重构和神经体液重构,即所谓的心动过速性心肌病。流行病学的调查证实,房颤是心力衰竭、脑卒中、死亡的独立危险因素。毫无疑问,尽早的转复并维持窦性心律给患者来带的血流动力学及其他方面的益处是室率控制策略不可比拟的,但是目前抗心律失常的治疗措施仍然不尽人意。十几年来,对房颤治疗的两种基本策略——室率控制和节律控制,结合抗栓治疗的临床研究一直没有停歇,然而这些研究似乎都得出一个结论:两种治疗策略对于整体房颤人群的预后没有显著性的差异。但是对这些临床研究的深层解读告诉我们:对房颤患者进行早期节律干预仍是我们的治疗目标。

Atrial fibrillation is the most common arrhythmia in clinic practice.It is still a challenge for cardiologist because of its epidemical prevalence and difficulty in treatment.Recent research revealed that overtime duration of arrhythmia may result in disorders like myocardial remodeling,electrical remodeling and neurohumoral remodeling,which is also called tachycardia induced cardiomyopathy.Besides,demographical investigation also confirms that atrial fibrillation is the independent risk factor of heart failure,stroke and death.Without question,early cardioversion and maintenance of sinus rhythm will bring hemodynamic and other benefit to atrial fibrillation population,which rate control can not afford.The only obstacle is the dissatisfactory effectiveness of current treatment of restoration and maintenance sinus rhythm.From 2000s to now,there were a series of clinical trials being concerning which strategy,rate control or rhythm control,is more beneficial than another,but seemingly all these endeavors failed to obtain a significant unanimity.But once we stepped into the deeper comprehension of these clinical trials,we were told that the rhythm intervention for atrial fibrillation population should always be our critical goal.