Tom 12, Nr 6 (2017)
Artykuł przeglądowy
Opublikowany online: 2017-12-29
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Strategia utrzymania rytmu zatokowego u pacjentów z niezastawkowym migotaniem przedsionków — stan wiedzy, kontrowersje, toczące się badania
DOI: 10.5603/FC.2017.0108
Folia Cardiologica 2017;12(6):570-579.
Streszczenie
Podstawowym problemem terapeutycznym u chorego z migotaniem przedsionków (AF), poza ustaleniem wskazań do leczenia przeciwkrzepliwego, jest wybór strategii utrzymania rytmu zatokowego lub kontroli częstości rytmu komór. W wytycznych z 2016 roku zaleca się wybór strategii utrzymania rytmu zatokowego „tylko” w celu zmniejszenia objawów wynikających z arytmii. W dotychczas przeprowadzonych badaniach nad wyborem strategii leczenia u pacjentów z AF nie ujawniono przewagi jednej strategii nad drugą. W wieloośrodkowych badaniach, takich jak AFFIRM, RACE, STAF, PIAF, HOT CAFE, nie wykazano różnic między obiema strategiami pod kątem umieralności oraz częstości powikłań sercowo-naczyniowych, choć w wielu analizach post-hoc przedstawiono dowody przewagi strategii utrzymania rytmu zatokowego, uwzględniając tak zwane miękkie punkty końcowe, takie jak poprawa wydolności fizycznej czy poprawa profilu humoralnego. Mimo zalecanego w wytycznych paradygmatu utrzymania rytmu zatokowego „tylko” do poprawy w zakresie objawów u pacjenta, badania obserwacyjne wskazują, że pacjentów z przywróconym i utrzymanym rytmem zatokowym cechuje lepsze rokowanie. A artykule przedstawiono aktualny stan wiedzy dotyczący wyboru strategii postępowania u pacjentów z niezastawkowym AF.
Słowa kluczowe: migotanie przedsionkówkardiowersjaleczenie antyarytmicznedoustne antykoagulanty
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