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首页> 外文期刊>Heartdrug: excellence in cardiovascular trials >Quality of Life in Atrial Fibrillation: Rhythm or Rate Control
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Quality of Life in Atrial Fibrillation: Rhythm or Rate Control

机译：房颤中的生活质量：节奏或费率控制

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The management of atrial fibrillation may be based either on rate control or rhythm control. Four recent randomized clinical trials have been undertaken to compare the benefits and risks of the two approaches, and none of the studies reported any advantage for the rhythm control strategy. On the basis of these data, numerous editorials have concluded that rate control can be considered the primary approach for the majority of patients with atrial fibrillation. This may be the pragmatic approach in clinical practice in the elderly mildly symptomatic patient with persistent atrial fibrillation. However, more data are needed on groups of patients and therapies underrepresented in these trials. Only a minority had extensive structural heart disease, and highly symptomatic patients were not enrolled. Furthermore, only three studies have compared quality of life (QoL), and only one study has used more than one QoL instrument. In the studies by Hohnloser et al. and Van Gelder et al. , QoL was assessed by a single generic instrument, and differences in important disease-specific dimensions (atrial-fibrillation-related symptoms) may have been overlooked. In all studies, QoL was significantly impaired compared to a general population of similar age . Improvements in QoL were noted in both treatment strategies, whereas only minor changes were observed in the study by Hagens et al. . There were no significant differences between the two treatment strategies in any of the studies. It is noteworthy that in these mildly symptomatic patients, who seemingly had a small burden of cardiac disease, QoL was impaired even after pharmacological treatment. These results can be readily compared with nonpharmacologic treatment strategies where patients burdened by severe symptoms caused by atrial fibrillation report enhanced QoL , and in some cases even normative levels are reached after nonpharmacologic intervention . Comparing the rate versus rhythm control approach, the impact of the pharmacological treatment strategies on QoL is in other words suboptimal and it may be argued that a greater use of nonpharmacologic therapies might have produced more favorable results with respect to the rhythm control strategy.The negative impact of atrial fibrillation on QoL should be evaluated in the context of other known hemodynamic and structural effects that have been described as a consequence of atrial fibrillation, i.e. loss of the atrial contribution to ventricular filling, irregularity in ventricular response leading to hemodynamic impairment and the- risk of achycardia-mediated ardiomyopathy. From this perspective, the rate control approach appears as a temporary strategy in the elderly mildly symptomatic patient with persistent atrial fibrillation. The ultimate goal for all patients with atrial fibrillation is still the maintenance of sinus rhythm, and the results from the above-mentioned four studies underlines the need for better treatment strategies, pharmacological as well as nonphar macological.
机译：房颤的管理可以基于速率控制或节奏控制。最近进行了四项随机临床试验，以比较两种方法的好处和风险，并且没有任何研究报告节奏控制策略的任何优势。根据这些数据，许多社论得出的结论可以将速率控制视为大多数心房颤动患者的主要方法。这可能是老年轻度症状患者持续性心房颤动的临床实践中的务实方法。但是，在这些试验中，需要更多的数据和患者组和疗法不足的疗法。只有少数人患有广泛的结构性心脏病，并且没有症状的患者没有入学。此外，只有三项研究比较了生活质量（QOL），只有一项研究使用了多个QOL仪器。在Hohnloser等人的研究中。和van Gelder等。 ，通过单个通用仪器评估了QOL，并且可能会忽略重要的疾病特异性维度（与心房 - 原纤维相关症状）的差异。在所有研究中，与年龄相似的普通人群相比，QOL受到显着损害。两种治疗策略中都发现了QOL的改善，而Hagens等人的研究仅观察到了微小的变化。 。在任何研究中，两种治疗策略之间均无显着差异。值得注意的是，在这些轻度症状的患者中，似乎有小小的心脏病负担，即使在药理学治疗后，QOL也受到了损害。与非药物治疗策略相比，这些结果可以很容易地比较，在这种策略中，由于心房颤动报告的严重症状负担增强了QOL，在某些情况下，在非药物干预后达到了规范水平。比较速率与节奏控制方法，药理学治疗策略对QOL的影响是次优的，可以说，更多地使用非药物疗法可能对节奏控制策略产生了更有利的结果。应在其他已知的血液动力学和结构作用的背景下评估房颤对QOL的影响，这些作用被描述为房颤的结果，即对心室填充的损失，对心室填充的贡献，对心室障碍的不规则性，导致血液动力学障碍和血液动力学障碍以及血液动力学障碍 - 疼痛介导的ARDIOMYOPATHY的风险。从这个角度来看，速率控制方法似乎是老年轻度症状的患者的临时策略，患有持续的房颤。所有心房颤动患者的最终目标仍然是维持鼻窦节奏，上述四项研究的结果强调了需要更好的治疗策略，药理和非镜头衡量。

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