Avtor/Urednik		Vokač, Damijan
Naslov		Zdravljenje atrijske fibrilacije z zdravili
Tip		članek
Vir		Slov Kardiol
Vol. in št.		Letnik 1, št. 2
Leto izdaje		2004
Obseg		str. 60-4
Jezik		slo
Abstrakt		Atrial fibrillation is a complex cardiac rhythm disorder, which is frequently complicated by thrombembolic events, such as disabling stroke. Medical therapy presents three basic approaches of management such as rhythm control, rate control and anticoagulation. Rhythm control consists of both conversion to sinus rhythm as well as it is used in prevention of relapses through longer period after cardioversion. Rate control is fundamental approach of chronic atrial fibrillation management as it is the first step in treatment of atrial fibrillation generally. In the subpopulation of chronic and ill patients with great possibility of atrial fibrillation relapses after cardioversion, a rate control is asole and only reasonable approach of treatment. There are several new agents under active investigation that are more atrial specific and will have great impact on success as well as on safety of atrial fibrillation management. Anticoagulation is an important issue in prevention of stroke and major disability due to other thromboembolic events of atrial fibrillation. New drugs, such as direct thrombin inhibitors will probably simplify anticoagulation therapy in the future, but before their broader use in clinical practice greater controlled comparative studies with warfarin are necessary.
Izvleček		Atrijska fibrilacija je zapletena, v osnovi sicer nemaligna motnja srčnega ritma, ki pa jo spremljajo številni zapleti (npr. možganska kap). Zdravljenje z zdravili sloni na treh osnovnih načelih: nadzoru srčnega ritma, nadzoru srčne frekvence in preprečevanju trombemboličnih zapletov. Pri nadzoru srčnega ritma sta poleg premene (konverzije) v sinusni ritem pomembna tudi njegovo vzdrževanje in preprečevanje ponovitev atrijske fibrilacije. Pri bolnikih, kjer pričakujemo številne ponovne napade atrijske fibrilacije, se običajno že primarno odločimo za nadzor frekvence. V razvoju je nekaj novejših antiaritmikov z atrijsko selektivnostjo, ki so sicer zelo obetavni, vendar so še v fazi predkliničnih in kliničnih raziskav. Od nove generacije atrijsko specifičnih antiaritmikov pričakujemo poleg večje uspešnosti tudi bolj varen način odmerjanja. Antikoagulacijsko zdravljenje je pomembna sestavina zdravljenja atrijske fibrilacije, s katero preprečujemo najpomebnejši zaplet, to je (ishemično) možgansko kap. Novejša zdravila, kot so neposredni zaviralci trombina, so učinkovita v preprečevanju možganskih kapi in lažja za odmerjanje, vendar bodo pred njihovo širšo uporabo potrebne večje primerjalne raziskave z varfarinom.
Deskriptorji		ATRIAL FIBRILLATION ANTI-ARRHYTHMIA AGENTS ANTICOAGULANTS