Left ventricular hypertrophy and antiarrhythmic drugs in atrial fibrillation: impact on mortality.
Left ventricular hypertrophy and antiarrhythmic drugs in atrial fibrillation: impact on mortality.
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DOI：
10.1111/pace.12426
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发表时间：
2014-10
期刊：
影响因子：
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通讯作者：
Chung MK
中科院分区：
文献类型：
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作者：
Chung R;Houghtaling PL;Tchou M;Niebauer MJ;Lindsay BD;Tchou PJ;Chung MK
尽管缺乏临床数据，目前的心房颤动（AF）指南倾向于将胺碘酮作为左心室肥厚（LVH）患者的首选药物。本研究验证了服用非胺碘酮类抗心律失常药物的持续性房颤和LVH患者比服用胺碘酮的患者死亡率更高的假设。在一项针对房颤转复患者的观察性队列分析中，纳入了首次转复前超声心动图诊断为左室壁厚度≥1.4 cm的LVH患者；收集临床资料，包括抗心律失常药物和射血分数（LVEF）。通过社会安全死亡指数确定的死亡率，使用Kaplan-Meier和Cox比例风险模型进行分析，以确定抗心律失常药物是否与较高的死亡率相关。3926例患者中，超声心动图壁厚1399例（年龄66.8±11.8岁，67%男性，LVEF 46±15%，隔膜1.3±0.4，后壁1.2±0.2 cm）， LVH≥1.4cm 537例（38%）。537例LVH患者平均年龄67.5±11.7岁，男性占76.4%，平均LVEF为48.3±13.3%。胺碘酮与较低的生存率相关（log rank p=0.001），包括调整年龄、LVEF和CAD后（p=0.023）。在不使用药物、非胺碘酮抗心律失常药物或胺碘酮治疗LVH的倾向评分匹配队列中（每组N=65），使用胺碘酮的患者早期生存率较低（p=0.05）。服用非胺碘酮类抗心律失常药物的持续性房颤和LVH患者的死亡率并不高于服用胺碘酮类抗心律失常药物的患者。重要的是，这些发现并不支持胺碘酮作为LVH患者的首选。
Despite sparse clinical data, current atrial fibrillation (AF) guidelines favor amiodarone as a drug of choice for patients with left ventricular hypertrophy (LVH). This study tested the hypothesis that patients with persistent AF and LVH on nonamiodarone antiarrhythmics have higher mortality compared to patients on amiodarone. In an observational cohort analysis of patients who underwent cardioversion for AF, patients with LVH, defined as left ventricular wall thickness ≥1.4 cm, by echocardiogram prior to their first cardioversion were included; clinical data, including antiarrhythmic drugs and ejection fraction (LVEF) were collected. Mortality, determined via the Social Security Death Index, was analyzed using Kaplan-Meier and Cox proportional hazards models to determine whether antiarrhythmic drugs were associated with higher mortality. In 3926 patients, echocardiographic wall thickness was available in 1399 (age 66.8±11.8 years, 67% male, LVEF 46±15%, septum 1.3±0.4, posterior wall 1.2±0.2 cm), and 537(38%) had LVH≥1.4cm. Among 537 patients with LVH, mean age was 67.5±11.7 years, 76.4% were males, and mean LVEF was 48.3±13.3%. Amiodarone was associated with lower survival (log rank p=0.001), including after adjusting for age, LVEF and CAD (p=0.023). In propensity-score matched cohorts with LVH treated with no drugs, non-amiodarone antiarrhythmic drugs or amiodarone (N=65 each group), there was early lower survival in patients on amiodarone (p=0.05). Patients with persistent AF and LVH on non-amiodarone antiarrhythmic drugs do not have higher mortality compared to patients on amiodarone. Importantly, these findings do not support amiodarone as a superior choice in patients with LVH.