摘要
心房纤颤(房颤)为最常见的持续性心律失常,在整个人群中的发病率为2%,美国约有220万房颤患者.其发病率随年龄增长而显著增高,Framingham的调查表明,50～59岁人群房颤发生率为0.5%,而在80～89岁人群房颤发生率为8.8%.
Atrial fibrillation (AF) is the most common sustained arrhythmia. Prevalence of AF increases with age. The risk of AF - associated thromboembolic events, which is a common complication of AF, is especially high in elderly individuals . Special consideration of these older patients should be paid to in the therapy strategy.
The prevention of thromboembolism, control of heart rate, restoration and maintenance of sinus rhythm are the goals of treatment for AF. Almost all the patients with AF should be anticoagulated with warfarin except there is contraindication . Randomized clinical trials found that the risk of hemorrhage has not been increased in elder padents under treatment of warfarin when the intensity falls in the range of 2.0 ～3.0 INR units.325 mg aspirin per day is also protective, whereas low dose shows no effect. Digoxin should not be the first choice to slow ventricular rate for its slow action and ineffectiveness in high sympathetic tone unless heart failure exist. Calcium antagonists or β- blockers are effective. Sotalol or amiodarone may be valuable because of their effects of slowing AVN conduction and prevention of recurrence of AF.Cardioversion to sinus rhythm should also be active in senior patients if indicated. Quinidine is no longer used extensively for its side effect of Tdp.With high rate of cardioversion and maintenance of sinus rhythm, amiodarone can be the first choice in elderly.The new drug Ibutilide, which was recently approved by FDA, is a promising antiarrhythmic agent in the treatment of AF. Because of the lack of oral form, the role of Ibutilide in the treatment of AF is not well defined.Overall, individualized therapy should be the most important principle in the pharmarcologic management of AF.
出处
《医学研究通讯》
2001年第1期2-6,共5页
Bulletin of Medical Research
