Beta-blockers or Digoxin for Atrial Fibrillation and Heart Failure?
Beta-blockers or Digoxin for Atrial Fibrillation and Heart Failure?
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DOI：
10.15420/cfr.2015:28:2
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发表时间：
2016-05-01
影响因子：
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通讯作者：
Babuty, Dominique
中科院分区：
文献类型：
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作者：
Fauchier, Laurent;Laborie, Guillaume;Babuty, Dominique
在伴有或不伴有收缩功能障碍的房颤（AF）和心力衰竭（HF）患者中，节律控制或心率控制是可接受的主要治疗选择。如果选择心率控制策略，几乎总是需要使用β受体阻滞剂治疗以实现心率控制。适当的心室率控制通常是每分钟小于100次的静息率，但较低的静息率可能是合适的。当AF与HF伴收缩功能障碍相关时，通常禁忌使用非二氢吡啶类钙通道阻滞剂。最近有关于β受体阻滞剂可能降低疗效以及地高辛治疗HF伴AF患者的安全性问题的争论。当存在AF时，β受体阻滞剂对射血分数降低的HF患者的生存获益可能较低。地高辛不能改善生存率，但与β受体阻滞剂联合使用可能有助于获得满意的心率控制。地高辛可能适用于低血压或β受体阻滞剂治疗的绝对禁忌症。
In patients with atrial fibrillation (AF) and heart failure (HF) with or without systolic dysfunction, either rhythm control or rate control is an acceptable primary therapeutic option. If a rate control strategy is chosen, treatment with a beta-blocker is almost always required to achieve rate control. Adequate ventricular rate control is usually a resting rate of less than 100 beats per minute, but lower resting rates may be appropriate. Non-dihydropyridine calcium channel blockers are often contraindicated when AF is associated with HF with systolic dysfunction. There have been recent debates on a possible reduced efficacy of beta-blockers as well as safety issues with digoxin when treating HF patients with AF. The benefit of beta-blockers on survival may be lower in patients with HF with reduced ejection fraction when AF is present. Digoxin does not improve survival but may help to obtain satisfactory rate control in combination with a beta-blocker. Digoxin may be useful in the presence of hypotension or an absolute contraindication to beta-blocker treatment.