beta受体阻断药在心力衰竭合并房颤治疗中的再评价

β肾上腺素受体阻断药被认定为心力衰竭治疗领域的里程碑,在心力衰竭指南中,β肾上腺素受体阻断药为IA类推荐。但针对慢性心力衰竭的经典、大型RCT临床试验中,房颤患者所占比率不高。新近对于心力衰竭合并房颤患者应用β肾上腺素受体阻断剂的死亡率和住院率进行Meta-分析示:β肾上腺素受体拮抗剂未见有更多临床获益(即死亡率和住院率减低水平无统计学意义)。本文就心力衰竭定义、心力衰竭时交感神经系统激活、作用于交感神经系统的β肾上腺素受体阻断药药理作用及分类、β肾上腺素受体阻断药在心力衰竭并发房颤治疗中应用地位、心力衰竭并发房颤患者应用β肾上腺素受体阻断药存在的争议及其原因分析进行简要综述。

Revaluation of the Outcome of Beta-blockers in Patients with Heart Failure and Atrial Fibrillation

Beta-blockers act as a cornerstone therapy for patients with heart failure (HF). The use of beta-blockers is a Class IA recommendation in current HF guidelines. However, enrollment of atrial fibrillation patients in the classic, large randomized control trials was limited. Recently, a meta-analysis of beta-blockers in heart failure and atrial fibriallation showed that the effect of beta-blocker did not predict a better outcome. Beta-blockade did not reduce mortality and was not associated with a reduction in hospitalization. In this review, we introduced the definition of heart failure, the activation of sympathetic nervous system in HF, the pharmacological profiles of beta-blockers, the first-line treatment of heart failure, and the reason for different effects of beta-blockers in heart failure patients with atrial fibrillation.