老年人房颤治疗方法的选择

Management of Atrial Fibrillation in the Elderly

老年人群房颤发病率高,缺血性脑卒中风险大,又是抗凝治疗导致出血的高危人群,因此要大胆地选择华法林抗凝治疗,并小心地严密监测INR值(1.6～2.5),严格控制其他出血危险因素。老年房颤心律失常的治疗重在个体化,重在改善症状,首选控制心室率;发作时血流动力学不稳定且药物不能满意地控制心室率时才选择复律治疗;症状明显而药物疗效欠佳患者可选择导管消融治疗。

The prevalence of atrial fibrillation（AF） is about 10 % in an elderly population. The elderly with AF has higher risk of thrombo--embolism and bleeding. Warfarin treatment is reasonably tolerated in elderly, and shows reduction in is- chaemic stroke. Rhythm control is little used in the elderly because sinus rhythm is often difficult to maintain. Rate control is the initial approach in elderly patients with AF. β--blockers and non-dihydropydine calcium channel antagonists and ef- fective for rate control. It is reasonable to initiate treatment with a lenient rate control protocol aimed at resting heart rate slower than 110 bpm. A stricter rate control strategy should be adopted when symptoms persist.