Management of Patients with Acute Heart Failure and Atrial Fibrillation

急性心衰竭患者合併心房纖維顫動之處理

陳隆景(Lung-Ching Chen) ； 周嘉裕(Chia-Yu Chou)

《重症醫學雜誌》 11卷3期 (2010/10) Pp. 188-191

https://doi.org/10.30035/TCCM.201010.0003

摘要

心房纖維顫動(Atrial fibrillation, AF)是急性心衰竭(Acute Heart failure)病患中常見之心律；大約佔所有心律20%到35%左右。急性心衰竭與AF常屬互爲因果之關係，以上兩者同時發生往往會使處置更爲複雜，並且進一步增加病患之死亡率。臨床醫師在處理急性心衰竭合併AF之病患時必須考慮及區分下列幾種不同之情況：1)病患爲新發生之急性心衰竭，併發新發生之AF：2)慢性心衰竭之病患併發新發生之AF：3)慢性心衰竭病患在急性惡化時所發生之慢性AF併發快速心室反應。除了區分上述三種不同情形以外，決定治療方式前另有幾個重要的問題必須同時考量，包括病患左心室收縮功能正常與否？AF發生時間之長短？病人是否已經接受任何心律不整或抗凝血藥物治療？以及病人有哪些合併病症。本文將就以上內容討論。

關鍵字

心房纖維顫動 ； 心衰竭 ； 抗心律不整藥物

並列摘要

Acute heart failure (AHF) patients are commonly encountered in intensive care units (ICUs) and their managements are challenging to intensivists. Atrial fibrillation (AF) is one of the most common cardiac rhythms among patients of AHF. It is estimated that 20% to 30% of AHF patients have rapid AF during acute stage of hospital admission. The relationship between AHF and AF is complex in the sense that they interact with each other. Acute heart failure will cause rapid AF, and rapid AF may in turn precipitate AHF. When the above 2 conditions present together, the morbidity and mortality of patients will increase, attributable to both the underlying disease condition and from the therapy used. Intensivists taking care of AHF patients with rapid AF should carefully evaluate the patient and consider 3 different situations: 1. Patients with newly onset acute heart failure with newly onset AF; 2. Patients of chronic heart failure with newly onset AF; and 3. Patients of decompensated chronic heart failure with chronic AF and rapid ventricular response. Other considerations which will influence the treatment strategy include: 1. Is the patient's baseline left ventricular systolic function preserved or reduced? 2. What is the duration of the AF episode? 3. Is the patient already treated with antiarrhythmic drugs for rhythm control or using only rate control agents, with or without anticoagulation? 4. What comorbidities are present? In this article management strategies according to different clinical scenarios will be discussed.

並列關鍵字

Atrial fibrillation ； Heart failure ； Antiarrhythmia agents