循環器ジャーナル72巻3号

2024年07月発行

特集 心房細動—予防・早期発見・治療の進化 Ⅲ.薬物を用いた不整脈治療（特に高齢者や腎機能低下例に対するもの）

レートコントロール——ジギタリスやβ遮断薬，Ca拮抗薬の使用は今どうなっている？

著者： 篠原徹二¹ 髙橋尚彦¹

所属機関： ¹大分大学医学部循環器内科・臨床検査診断学講座

ページ範囲：P.392 - P.399

POINT
●心房細動患者に対するリズムコントロール療法は，その有用性が見直されてきている．
●一方，洞調律維持困難な患者には，レートコントロール療法は有用な治療選択である．
●レートコントロール療法における第一選択の薬剤は，β遮断薬である．

参考文献

1）Wyse DG, Waldo AL, DiMarco JP, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 2002 ; 347 : 1825-33.

2）Kirchhof P, Camm AJ, Goette A, et al. Early rhythm-control therapy in patients with atrial fibrillation. N Engl J Med 2020 ; 383 : 1305-16.

3）日本循環器学会，日本不整脈心電学会．2024年JCS/JHRSガイドライン フォーカスアップデート版 不整脈治療．https://www.j-circ.or.jp/cms/wp-content/uploads/2024/03/JCS2024_Iwasaki.pdf（2024年4月閲覧）

4）Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke : the Framingham Study. Stroke 1991 ; 22 : 983-8.

5）Marrouche NF, Brachmann J, Andresen D, et al. Catheter ablation for atrial fibrillation with heart failure. N Engl J Med 2018 ; 378 : 417-27.

6）Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery（EACTS） : The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology（ESC）Developed with the special contribution of the European Heart Rhythm Association（EHRA）of the ESC. Eur Heart J 2021 ; 42 :373-498.

7）Van Gelder IC, Groenveld HF, Crijns HJ, et al ; RACE II Investigators. Lenient versus strict rate control in patients with atrial fibrillation. N Engl J Med 2010 ; 362 : 1363-73.

8）Kato Y, Suzuki S, Uejima T, et al. The relationship between resting heart rate and peak VO2 : A comparison of atrial fibrillation and sinus rhythm. Eur J Prev Cardiol 2016 ; 23 : 1429-36.

9）Nagai R, Kinugawa K, Inoue H, et al ; J-Land Investigators. 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 2013 ; 77 : 908-16.

10）Yamashita T, Ikeda T, Akita Y. Comparison of heart rate reduction effect and safety between bisoprolol transdermal patch and bisoprolol fumarate oral formulation in Japanese patients with persistent/permanent atrial fibrillation（BISONO-AF study）. J Cardiol 2019 ; 73 : 386-93.

11）Fauchier L, Grimard C, Pierre B, et al. Comparison of beta blocker and digoxin alone and in combination for management of patients with atrial fibrillation and heart failure. Am J Cardiol 2009 ; 103 : 248-54.

12）Kotecha D, Holmes J, Krum H, et al. Beta-Blockers in Heart Failure Collaborative Group. Efficacy of β blockers in patients with heart failure plus atrial fibrillation : an individual-patient data meta-analysis. Lancet 2014 ; 384 : 2235-43.

13）Li SJ, Sartipy U, Lund LH, et al. Prognostic significance of resting heart rate and use of β-blockers in atrial fibrillation and sinus rhythm in patients with heart failure and reduced ejection fraction : findings from the Swedish Heart Failure Registry. Circ Heart Fail 2015 ; 8 : 871-9.

14）Nielsen PB, Larsen TB, Gorst-Rasmussen A, et al. β-Blockers in atrial fibrillation patients with or without heart failure : association with mortality in a nationwide cohort study. Circ Heart Fail 2016 ; 9 : e002597.

15）Cadrin-Tourigny J, Shohoudi A, Roy D, et al. Decreased mortality with beta-blockers in patients with heart failure and coexisting atrial fibrillation : An AF-CHF Substudy. JACC Heart Fail 2017 ; 5 : 99-106.

16）Washam JB, Stevens SR, Lokhnygina Y, et al. ROCKET AF Steering Committee and Investigators. Digoxin use in patients with atrial fibrillation and adverse cardiovascular outcomes : a retrospective analysis of the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation（ROCKET AF）. Lancet 2015 ; 385 : 2363-70.

17）日本循環器学会，日本心不全学会．2021年JCS/JHFSガイドライン フォーカスアップデート版 急性・慢性心不全診療．https://www.j-circ.or.jp/cms/wp-content/uploads/2021/03/JCS2021_Tsutsui.pdf（2024年4月閲覧）

18）Kotecha D, Bunting KV, Gill SK, et al. Effect of digoxin vs bisoprolol for heart rate control in atrial fibrillation on patient-reported quality of life : The RATE-AF randomized clinical trial. JAMA 2020 ; 324 : 2497-508.

19）Rathore SS, Curtis JP, Wang Y, et al. Association of serum digoxin concentration and outcomes in patients with heart failure. JAMA 2003 ; 289 : 871-8.