Abstract：
The global prevalence of atrial fibrillation (AF) is rising, paralleling increased life expectancy. Early rhythm control benefits AF management. However, in low-risk, often asymptomatic, AF patients, anticoagulant monotherapy is the selected treatment, aligning with current guidelines. However, early AF progression in these low-risk individuals is not well-understood. Thus, this study aims to: 1) determine the proportion of low-risk AF patients who worsen within a year of initial AF diagnosis and 2) identify risk factors such treatment transitions. We analyzed data from 18623 AF patients, spanning January 2005 to June 2017. Low-risk patients were those on anticoagulant monotherapy ± rate control, following the JCS/JHRS 2020 Guideline on Pharmacotherapy of Cardiac Arrhythmias. We defined 2 patterns of treatment transition for 1) initiating ablation or antiarrhythmic drug therapy and 2) solely using antiarrhythmic drugs. This retrospective cohort study was employed a 12-month study, following a 6-month screening period. We included 1874 patients for all rhythm control (analysis 1) and 1503 for only medication-based control (analysis 2). The primary endpoint, treatment transition of AF under monotherapy, occurred in 28.4% of patients in analysis 1 and 10.8% in analysis 2. Risk factors common to both scenarios were male gender, baseline rate control drug use, and rivaroxaban selection, as identified by multiple logistic regression. These findings suggest a higher AF treatment transition trend in patients starting rivaroxaban, calling for further research. The study highlights the importance of informed early rhythm control initiation decisions in clinical settings.
摘要：
房颤（AF）的全球患病率正在上升，平行增加预期寿命。早期节律控制有利于房颤管理。然而,在低风险中，通常无症状，房颤患者,抗凝单一疗法是选定的治疗方法，符合当前的指导方针。然而,这些低危个体的房颤早期进展尚不清楚.因此，本研究旨在:1)确定在初始房颤诊断后1年内病情恶化的低危房颤患者比例,2)确定此类治疗过渡的风险因素.我们分析了18623例房颤患者的数据，从2005年1月到2017年6月。低风险患者为接受抗凝单药治疗±速率控制的患者，遵循JCS/JHRS2020《心律失常药物治疗指南》。我们定义了2种治疗过渡模式，用于1）开始消融或抗心律失常药物治疗和2）仅使用抗心律失常药物。这项回顾性队列研究采用了一项为期12个月的研究，经过6个月的筛查。我们纳入了1874例患者的所有节律控制（分析1）和1503例仅基于药物的控制（分析2）。主端点，单一疗法下房颤的治疗过渡，分析1中28.4%的患者和分析2中10.8%的患者发生.两种情况下常见的风险因素是男性，基线率控制药物使用，和利伐沙班选择，通过多元逻辑回归确定。这些研究结果表明，开始使用利伐沙班的患者有更高的房颤治疗过渡趋势。呼吁进一步研究。该研究强调了在临床环境中明智的早期节律控制启动决策的重要性。
