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心房顫動治療的新進展

Update in Atrial Fibrillation Treatment

摘要


心房顫動是心房的電氣訊號紊亂,導致心房失去健康,進而影響整顆心臟以及全身的疾病,雖然我們很想要控制心律,也就是竇律控制,但苦於沒有好而安全的方法可達到這個目的,退而求其次的策略就是室律控制,保住心臟的部分功能,並用抗凝血劑作中風預防。然而隨著我們對心房顫動的了解以及科技的進步,越來越多的電燒工具以及方法應運而生,這些新方法的誕生不外乎是為減少手術時間、增加手術成功率、減少手術併發症、減少長期復發率,幫助病患更容易達到竇律控制的目的,不過新的方法和工具總是需要時間來證明它的效果與安全性,我們應該審慎評估,希望能以最小的風險及破壞,為病患謀得最大的利益。

並列摘要


Atrial fibrillation is a disease that has chaotic atrial electrical signals. The rapid atrial firing causes atrial myocardium damage, and eventually affecting the whole heart and the whole body. Though we know the best strategy is to suppress the fibrillation waves and maintain sinus rhythm, we actually do not have good methods or tools to achieve this goal. Instead of rhythm control, we choose rate control to protect at least the ventricles and also use the anti-coagulants for stroke prevention. With more and more understandings about the atrial fibrillation, we now have the tools designed for pulmonary vein isolation. New methods or tools are built for shorter procedure time, higher successful rate, lower recurrence rate and lower complication rate. But for the new methods, it is always time that can prove the efficacy and the safety in a long run. We need to always update ourselves for new clinical data, and always search for the maximum benefit while minimizing the risks for the patients.

參考文獻


Vaughan Williams EM: Classification of antidysrhythmic drugs. Pharmacol Ther B 1975;1:115-38.
Wyse DG, Waldo AL, DiMarco JP, et al: A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 2002;347:1825-33.
Liang JJ, Silvestry FE: Mechanistic insights into mitral regurgitation due to atrial fibrillation: "Atrial functional mitral regurgitation". Trends Cardiovasc Med 2016;26:681-9.
Delgado V, Bax JJ: Atrial Functional Mitral Regurgitation: From Mitral Annulus Dilatation to Insufficient Leaflet Remodeling. Circ Cardiovasc Imaging 2017;10(3). pii: e006239.
Ito K, Abe Y, Takahashi Y, et al: Mechanism of atrial functional mitral regurgitation in patients with atrial fibrillation: A study using three-dimensional transesophageal echocardiography. J Cardiol 2017;70:584-90.

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