■心房颤动是最常见的持续性心律失常,与显著的发病率和死亡率相关。一些试验表明,在选择节律控制策略而不是速率控制策略时,没有死亡率益处。一些试验表明死亡率增加。使用AFFIRM试验数据库,我们试图确定节律控制策略对正常或轻度心房扩大患者的影响。
■AFFIRM试验数据库用于评估心律控制策略与心率控制策略在左心房(LA)正常至轻度增大患者亚组中的效果。这项研究的主要结果指标是全因死亡率,心血管死亡率,非心血管死亡率,和住院/ED访问。
■我们从AFFIRM试验中确定了一个具有正常或轻度LA增大的受试者亚组(n=4060名受试者中的2022名)。与速率对照组(n=1000)相比,节律对照组(n=1022)的受试者全因死亡率风险增加了34%(RR1.34,95%CI1.08-1.67;P=0.007),住院/ED就诊风险增加了10%(RR1.10,95%CI1.05-2.16;P=<0.001)。
■这项研究表明,与心率控制策略相比,节律控制策略增加了正常至轻度心房扩大患者亚组的死亡率和住院风险。胺碘酮在此亚组患者中的使用可能推动了这些发现。
UNASSIGNED: Atrial fibrillation is the most commonly encountered sustained arrhythmia and is associated with significant morbidity and mortality. Several trials have demonstrated that no mortality benefit exists when choosing a rhythm-control strategy over a rate-control strategy, with some trials suggesting an increase in mortality. Using the AFFIRM trial database we sought to determine the effect of rhythm control strategy in patients with normal or mild atrial enlargement.
UNASSIGNED: AFFIRM Trial database was used to evaluate the effect of rhythm-control strategy compared to rate-control strategy in a subgroup of patients with normal to mild left atrial (LA) enlargement. The primary outcome measures of this study were all-cause mortality, cardiovascular mortality, non-cardiovascular mortality, and hospitalization/ED visit.
UNASSIGNED: We identified a subgroup of subjects from the AFFIRM trial with normal or mild LA enlargement (n=2022 of 4060 total subjects). Subjects in the rhythm-control group(n= 1022) had an increased risk of all-cause mortality by 34% (RR 1.34, 95% CI 1.08-1.67; P=0.007) and hospitalization/ED visits by 10% (RR 1.10, 95% CI 1.05-2.16; P=<0.001) compared to rate control group(n= 1000).
UNASSIGNED: This study demonstrated that rhythm-control strategy increases the risk of mortality and hospitalization in a subgroup of patients with normal to mild atrial enlargement compared to rate-control strategy. Amiodarone use in this subgroup of patients likely drove these findings.