Delayed rhythm control of atrial fibrillation may be a cause of failure to prevent recurrences: reasons for change to active antiarrhythmic treatment at the time of the first detected episode
Delayed rhythm control of atrial fibrillation may be a cause of failure to prevent recurrences: reasons for change to active antiarrhythmic treatment at the time of the first detected episode
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DOI：
10.1093/europace/eum276
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发表时间：
2008-01-01
期刊：
影响因子：
6.1
通讯作者：
Crijns, Harry
中科院分区：
文献类型：
--
作者：
Cosio, Francisco G.;Aliot, Etienne;Crijns, Harry
心房颤动（AF）与功能能力和生活质量受损以及显著的发病率和死亡率有关。目前的治疗方法不能维持大多数患者稳定的窦性心律（SR）。多年来，指南建议只有在房颤耐受性差的情况下才对首次房颤发作进行抗心律失常治疗，这一立场得到了研究的加强，表明心律控制没有死亡率或发病率优势。在过去的十年中，研究表明AF的自我延续机制是基于AF本身引起的电生理和结构重塑。越来越多的证据表明，“单发”房颤是由一系列因素引起的，其中一些因素可能很容易治疗，如高血压、急性呼吸暂停和肥胖，因此可以在房颤首次发作时进行二级预防。根据这些概念，缺乏早期干预可能是长期无法维持房颤的原因之一。在这篇立场论文中，我们提出测试工作假设，如果选择了一种房颤维持策略，房颤的治疗应在首次发现房颤时开始，并应基于恢复房颤和积极治疗促进房颤的相关疾病的双重策略。改造。
Atrial fibrillation (AF) is associated with impaired functional capacity and quality of life and significant morbidity and mortality. The current management approach fails to maintain stable sinus rhythm (SR) in the majority of patients. For many years, guidelines have recommended antiarrhythmic treatment of a first AF episode only if the AF is poorly tolerated, a position that has been reinforced by studies showing no mortality or morbidity advantage of rhythm control over rate control. During the last decade, research has shown mechanisms of self-perpetuation of AF based on electrophysiological and structural remodelling induced by AF itself. There is mounting evidence that 'lone' AF is because of a host of factors, some of which may be easily treatable, such as hypertension, steep apnoea, and obesity, thus allowing secondary prevention at the time of the first episode of AF. According to these concepts, lack of early intervention could be one of the reasons for long-term failure of maintenance of SR. In this position paper, we propose testing the working hypothesis that if an SR maintenance strategy is selected, treatment of AF should commence at the first-detected episode and should be based on a double strategy of SR restoration and aggressive treatment of associated conditions that promote atrial. remodelling.