心房颤动的药物复律治疗进展

Study Progress in Pharmacological Cardioversion of Atrial Fibrillation

心房颤动(房颤)是临床最常见的心律失常,目前用于房颤复律的有效药物包括Ⅰc类抗心律失常药物(氟卡尼、普罗帕酮、吡西卡尼)和Ⅲ类抗心律失常药物(胺碘酮、伊布利特、多非利特、维纳卡兰、尼非卡兰)。氟卡尼、普罗帕酮、伊布利特是非器质性心脏病患者房颤复律的首选;维纳卡兰、伊布利特可用于轻度心力衰竭及缺血性心脏病患者的房颤复律;而器质性心脏病患者房颤复律首选胺碘酮。吡西卡尼、多非利特、尼非卡兰在房颤复律中的应用还需进一步探究,抗心律失常药物的联合应用是房颤药物治疗的研究方向。

Atrial fibrillation is the most common tachyarrhythmia encountered in clinical practice. Effective drugs for atrial fibrillation are the class Ⅰ antiarrhythmic drugs( flecainide,propafenone,pilsicainide) and the class Ⅲ antiarrhythmic drugs( amiodarone,ibutilide,dofetilide,vernakalant,nifekalant). Flecainide,propafenone and ibutilide can be used in patients without structural heart disease. Vernakalant and ibutilide can be given to patients with heart failure,including those with ischemic heart disease. Amiodarone can be used in patients with structural heart disease. The application of pilsicainide,dofetilide and nifekalant in conversion of atrial fibrillation needs further exploration,and the combination of antiarrhythmia drugs is also the direction of the future research.