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Abstract

第1巻 2005年4月 第2号

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■臨床医のために

心房細動に対する治療戦略―洞調律化か,心拍数コントロールか?
小林 義典
日本医科大学内科学第一教室

Therapeutic Options for Atrial Fibrillation: Rhythm Control or Rate Control Strategy
Yoshinori Kobayashi
First Department of Internal Medicine, Nippon Medical School

Recently therapeutic options for the treatment of atrial fibrillation (AF) became more extent, as pharmacological and mapping technology develop. However, the treatment for the restoration and maintenance of sinus rhythm in patients with persistent AF and progressed atrial remodeling remains unsatisfied even utilizing both pharmacological and non-pharmacological therapies. Up to present, there are a total of 5 clinical randomized trials investigating which therapeutic strategy (rhythm control or rate control) is superior in terms of improvement in the patients'prognosis and quality of life. In all the trials, there were no significant differences in the incidence of end-points including all-cause death, embolic and hemorrhagic events between two strategies, although the cumulative mortality tended to be higher for the rhythm control strategy in AFFIRM trial. On the contrary, exercise tolerance (6 minutes walk) was improved to the greater degree for the rhythm control strategy in PIAF trial. Because most of these trials recruited the patients with high risk patients of thrombo-embolic complications such as older age, persistent or chronic AF, reduced cardiac function and so on, it is suggested that the rhythm control therapy might improve the QOL and even mortality, by selecting candidates appropriately for the rhythm control therapy.

日医大医会誌 2005; 1(2), 74-78

Key words
atrial fibrillation, rate control strategy, rhythm control strategy, antiarrhythmic agents, catheter ablation

Correspondence to
Yoshinori Kobayashi, First Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
E-mail:kobaya-y@nms.ac.jp

受付:2004年12月28日 受理:2005年2月2日

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