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特集 不整脈診療—ずっと疑問・まだ疑問 Ⅰ．不整脈診療のベーシック
心不全と心房細動とβ遮断薬
著者： 小川正浩1
所属機関： 1福岡大学医学部心臓・血管内科学
ページ範囲：P.409 - P.415
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・心不全と心房細動はしばしば共存し，一方が一方を増悪させ，心不全の増悪，心房細動持続の長期化，血栓塞栓症や突然死を引き起こしやすく，生命予後を悪化させる．
・β遮断薬は，心不全の治療薬として，またAFリズムおよびレートコントロール薬として有用であるが，慢性化したAFのレートコントロールは必ずしも心拍数を厳格に低下させる必要はなく，症例により使い分けや用量調節することが肝要である．
・心不全合併心房細動に対するカテーテルアブレーションは，薬物治療に比べて洞調律維持，予定外入院の減少や予後改善効果が見込まれる．
・心不全と心房細動はしばしば共存し，一方が一方を増悪させ，心不全の増悪，心房細動持続の長期化，血栓塞栓症や突然死を引き起こしやすく，生命予後を悪化させる．
・β遮断薬は，心不全の治療薬として，またAFリズムおよびレートコントロール薬として有用であるが，慢性化したAFのレートコントロールは必ずしも心拍数を厳格に低下させる必要はなく，症例により使い分けや用量調節することが肝要である．
・心不全合併心房細動に対するカテーテルアブレーションは，薬物治療に比べて洞調律維持，予定外入院の減少や予後改善効果が見込まれる．
参考文献
1) Anter E, Jessup M, Callans DJ:Atrial fibrillation and heart failure:treatment considerations for a dual epidemic. Circulation 119:2516-2525, 2009
2) Santhanakrishnan R, Wang N, Larson MG, et al:Atrial fibrillation begets heart failure and vice versa:temporal associations and differences in preserved versus reduced ejection fraction. Circulation 133:484-492, 2016
3) Odutayo A, Wong CX, Hsiao AJ, et al:Atrial fibrillation and risks of cardiovascular disease, renal disease, and death:systematic review and meta-analysis. BMJ 354:i4482, 2016
4) Healey JS, Oldgren J, Ezekowitz M, et al:Occurrence of death and stroke in patients in 47 countries 1 year after presenting with atrial fibrillation:a cohort study. Lancet 388:1161-1169, 2016
5) Jons C, Jacobsen UG, Joergensen RM, et al:The incidence and prognostic significance of new-onset atrial fibrillation in patients with acute myocardial infarction and left ventricular systolic dysfunction:a CARISMA substudy. Heart Rhythm 8:342-348, 2011
6) Santini M, Gasparini M, Landolina M, et al:Device-detected atrial tachyarrhythmias predict adverse outcome in real-world patients with implantable biventricular defibrillators. J Am Coll Cardiol 57:167-172, 2011
7) Chatterjee S, Biondi-Zoccai G, Abbate A, et al:Benefits of beta blockers in patients with heart failure and reduced ejection fraction:network meta-analysis. BMJ 346:f55, 2013
8) Kotecha D, Holmes J, Krum H, et al:Efficacy of beta blockers in patients with heart failure plus atrial fibrillation:an individual-patient data meta-analysis. Lancet 384:2235-2243, 2014
9) McMurray J, Kober L, Robertson M, et al:Antiarrhythmic effect of carvedilol after acute myocardial infarction:results of the Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction（CAPRICORN）trial. J Am Coll Cardiol 45:525-530, 2005
10) Moss AJ, Hall WJ, Cannom DS, et al:Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med 361:1329-1338, 2009
11) Ruwald MH, Ruwald AC, Jons C, et al:Effect of metoprolol versus carvedilol on outcomes in MADIT-CRT（multicenter automatic defibrillator implantation trial with cardiac resynchronization therapy）. J Am Coll Cardiol 61:1518-1526, 2013
12) Ruwald MH, Abu-Zeitone A, Jons C, et al:Impact of carvedilol and metoprolol on inappropriate implantable cardioverter-defibrillator therapy:the MADIT-CRT trial（Multicenter Automatic Defibrillator Implantation With Cardiac Resynchronization Therapy）. J Am Coll Cardiol 62:1343-1350, 2013
13) Aleong RG, Sauer WH, Sauer WH, et al:Prevention of atrial fibrillation by bucindolol is dependent on the beta1389 Arg/Gly adrenergic receptor polymorphism. JACC Heart Fail 1:338-344, 2013
14) Roy D, Talajic M, Nattel S, et al:Rhythm control versus rate control for atrial fibrillation and heart failure. N Engl J Med 358:2667-2677, 2008
15) Wijesurendra RS, Liu A, Eichhorn C, et al:Lone atrial fibrillation is associated with impaired left ventricular energetics that persists despite successful catheter ablation. Circulation 134:1068-1081, 2016
16) Di Biase L, Mohanty P, Mohanty S, et al:Ablation versus amiodarone for treatment of persistent atrial fibrillation in patients with congestive heart failure and an implanted device:results from the AATAC multicenter randomized trial. Circulation 133:1637-1644, 2016
17) Nagai R, Kinugawa K, Inoue H, et al:Urgent management of rapid heart rate in patients with atrial fibrillation/flutter and left ventricular dysfunction:comparison of the ultra-short-acting β1-selective blocker landiolol with digoxin（J-Land Study）. Circ J 77:908-916, 2013
18) Ponikowski P, Voors AA, Anker SD, et al:2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure:the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology（ESC）developed with the special contribution of the Heart Failure Association（HFA）of the ESC. Eur Heart J 37:2129-2200, 2016
19) Chao TF, Liu CJ, Tuan TC, et al:Rate-control treatment and mortality in atrial fibrillation. Circulation 132:1604-1612, 2015
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