A comparison of rate control and rhythm control in patients with atrial fibrillation
A comparison of rate control and rhythm control in patients with atrial fibrillation
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DOI：
10.1056/nejmoa021328
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发表时间：
2002-12-05
影响因子：
158.5
通讯作者：
Corley, SD
中科院分区：
文献类型：
--
作者：
Wyse, DG;Waldo, AL;Corley, SD
背景资料：房颤的治疗有两种方法：一种是复律和抗心律失常药物治疗以维持窦性心律，另一种是使用心率控制药物，使房颤持续存在。在这两种方法中，抗凝药物的使用recommended.Methods：我们进行了一项随机，多中心比较这两种治疗策略的房颤患者和中风或死亡的高风险。结果：共有4060例患者（平均[+/-SD]年龄，69.7+/-9.0岁）参加了这项研究; 70.8%有高血压病史，38.2%有冠状动脉疾病。3311例超声心动图显示左房增大者占64.7%，左室功能减退者占26.0%。在接受节律控制治疗的患者中有356人死亡，在接受心率控制治疗的患者中有310人死亡（5年死亡率分别为23.8%和21.3%;风险比为1.15 [95%置信区间为0.99至1.34]; P=0.08）。节律控制组的住院患者多于心率控制组，节律控制组的药物不良反应也更多。在这两组中，大多数中风发生后，华法林已经停止或国际标准化比率是subtherapeutic.Conclusions：管理房颤的节奏控制策略提供了没有生存优势的速率控制策略，并有潜在的优势，如药物不良反应的风险较低，与速率控制策略。这组高危患者应继续抗凝治疗。
Background: There are two approaches to the treatment of atrial fibrillation: one is cardioversion and treatment with antiarrhythmic drugs to maintain sinus rhythm, and the other is the use of rate-controlling drugs, allowing atrial fibrillation to persist. In both approaches, the use of anticoagulant drugs is recommended.Methods: We conducted a randomized, multicenter comparison of these two treatment strategies in patients with atrial fibrillation and a high risk of stroke or death. The primary end point was overall mortality.Results: A total of 4060 patients (mean [+/-SD] age, 69.7+/-9.0 years) were enrolled in the study; 70.8 percent had a history of hypertension, and 38.2 percent had coronary artery disease. Of the 3311 patients with echocardiograms, the left atrium was enlarged in 64.7 percent and left ventricular function was depressed in 26.0 percent. There were 356 deaths among the patients assigned to rhythm-control therapy and 310 deaths among those assigned to rate-control therapy (mortality at five years, 23.8 percent and 21.3 percent, respectively; hazard ratio, 1.15 [95 percent confidence interval, 0.99 to 1.34]; P=0.08). More patients in the rhythm-control group than in the rate-control group were hospitalized, and there were more adverse drug effects in the rhythm-control group as well. In both groups, the majority of strokes occurred after warfarin had been stopped or when the international normalized ratio was subtherapeutic.Conclusions: Management of atrial fibrillation with the rhythm-control strategy offers no survival advantage over the rate-control strategy, and there are potential advantages, such as a lower risk of adverse drug effects, with the rate-control strategy. Anticoagulation should be continued in this group of high-risk patients.