作者：马军枝，李天骄，安东，高琳，李树仁

单位：

1.050017河北省石家庄市，河北医科大学研究生学院　2.050000河北省石家庄市，河北省人民医院心内一科　3.050000河北省石家庄市，河北省人民医院体检中心　4.075000河北省张家口市，河北北方学院研究生学院

Units：

1.Graduate School of Hebei Medical University, Shijiazhuang 050017, China2.Department of Cardiovascular Internal Medicine, Hebei General Hospital, Shijiazhuang 050000, China3.Physical Examination Center, Hebei General Hospital, Shijiazhuang 050000, China4.Graduate School of Hebei North University, Zhangjiakou 075000, China

关键词：

心房颤动；节律控制；抗心律失常药；消融技术；综述

Keywords：

Atrial fibrillation; Rhythm control; Anti-arrhythmia agents; Ablation techniques; Review

CLC：

R 541.75

DOI：

10.12114/j.issn.1008-5971.2023.00.231

Funds：

政府资助临床医学优秀人才培养项目（2021048）

摘要：

心房颤动是临床常见的持续性心律失常类型，其与血栓栓塞并发症、心力衰竭和其他心血管事件发生风险增加相关。因此，早期阻止心房颤动进展对改善患者预后具有重要意义。根据治疗目标，心房颤动的心律管理模式可以分为“心率控制”和“节律控制”，其中节律控制指恢复并维持窦性心律，是改善心房颤动患者症状的主要治疗措施之一，也是心房颤动治疗的一个重要目标。近年来随着循证证据的积累，临床更加重视通过节律控制（包括抗心律失常药和/或消融技术）来减少心房颤动患者不良心血管结局。基于此，本文主要总结了支持心房颤动患者采取早期节律控制的证据，并从药物治疗（Ⅰc类和Ⅲ类抗心律失常药）和非药物治疗（射频导管消融术、冷冻球囊消融术、热球囊消融术及脉冲电场消融术等消融方法）角度分析了心房颤动的早期节律控制策略，以期为改善心房颤动患者预后提供参考。

Abstract：

Atrial fibrillation is a common type of persistent arrhythmia in clinical practice, which is associated withincreased risk of thromboembolism complications, heart failure and other cardiovascular events. Therefore, early prevention ofatrial fibrillation progression is of great significance for improving the prognosis of patients. According to the treatment objectives,the rhythm management mode of atrial fibrillation can be divided into "heart rate control" and "rhythm control" . Rhythm controlrefers to the recovery and maintenance of sinus rhythm. It is one of the main treatment measures to improve the symptoms ofpatients with atrial fibrillation and an important goal of atrial fibrillation treatment. In recent years, with the accumulation of evidence-based evidence, clinical attention has been paid to reduce adverse cardiovascular outcomes in patients with atrialfibrillation through rhythm control (including antiarrhythmic drugs and/or atrial fibrillation ablation) . Based on this, this papermainly summarizes the evidence supporting early rhythm control in patients with atrial fibrillation, and summarizes the earlyrhythm control strategies of atrial fibrillation from the perspective of drug therapy (classⅠc and class Ⅲ antiarrhythmic drugs)and non-drug therapy (radio frequency ablation, cryoballoon ablation, hyperthermia balloon ablation and pulsed field ablation) ,in order to provide reference for improving the prognosis of patients with atrial fibrillation.

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