Hohnloser S H, Kuck K H, Lilienthal J
JW Goethe University, Frankfurt, Germany.
Lancet. 2000 Nov 25;356(9244):1789-94. doi: 10.1016/s0140-6736(00)03230-x.
Atrial fibrillation is the most commonly encountered sustained cardiac arrhythmia. Restoration and maintenance of sinus rhythm is believed by many physicians to be superior to rate control only. However, there are no prospective data that compare both therapeutic strategies.
The Pharmacological Intervention in Atrial Fibrillation (PIAF) trial was a randomised trial in 252 patients with atrial fibrillation of between 7 days and 360 days duration, which compared rate (group A, 125 patients) with rhythm control (group B, 127 patients). In group A, diltiazem was used as first-line therapy and amiodarone was used in group B. The primary study endpoint was improvement in symptoms related to atrial fibrillation.
Over the entire observation period of 1 year, a similar proportion of patients reported improvement in symptoms in both groups (76 responders at 12 months in group A vs 70 responders in group B, p=0.317). Amiodarone administration resulted in pharmacological restoration of sinus rhythm in 23% of patients. Walking distance in a 6 min walk test was better in group B compared with group A, but assessment of quality of life showed no differences between groups. The incidence of hospital admission was higher in group B (87 [69%] out of 127 vs 30 [24%] out of 125 in group A, p=0.001). Adverse drug effects more frequently led to a change in therapy in group B (31 [25%] patients compared with 17 [14%] in group A, p=0.036).
With respect to symptomatic improvement in patients with atrial fibrillation, the therapeutic strategies of rate versus rhythm control yielded similar clinical results overall. However, exercise tolerance is better with rhythm control, although hospital admission is more frequent. These data may serve as a basis to select therapy in individual patients.
心房颤动是最常见的持续性心律失常。许多医生认为恢复并维持窦性心律优于单纯控制心率。然而，尚无前瞻性数据比较这两种治疗策略。
心房颤动的药物干预（PIAF）试验是一项针对252例房颤持续时间在7天至360天之间患者的随机试验，比较了心率控制组（A组，125例患者）和节律控制组（B组，127例患者）。A组以地尔硫䓬作为一线治疗药物，B组使用胺碘酮。主要研究终点是与房颤相关症状的改善情况。
在整个1年的观察期内，两组报告症状改善的患者比例相似（A组12个月时有76例症状改善，B组有70例，p = 0.317）。服用胺碘酮使23%的患者实现了窦性心律的药物性恢复。6分钟步行试验中的步行距离B组优于A组，但生活质量评估显示两组之间没有差异。B组的住院率更高（127例中有87例[69%]，A组125例中有30例[24%]，p = 0.001）。药物不良反应导致B组更频繁地改变治疗方案（31例[25%]患者，而A组为17例[14%]，p = 0.036）。
就房颤患者的症状改善而言，心率控制与节律控制的治疗策略总体上产生了相似的临床结果。然而，节律控制时运动耐量更好，尽管住院更频繁。这些数据可为个体患者选择治疗方法提供依据。
