Riva S, Tondo C, Carbucicchio C, Galimberti P, Fassini G, Della Bella P
Istituto di Cardiologia dell'Università degli Studi, CNR, Centro Cardiologico Fondazione Monzino, IRCCS, Milan, Italy.
Europace. 1999 Oct;1(4):242-7. doi: 10.1053/eupc.1999.0048.
To investigate the rate of transformation of atrial fibrillation to atrial flutter in patients taking antiarrhythmic drugs for the prophylaxis of atrial fibrillation, we retrospectively analysed data from 305 consecutive patients with paroxysmal atrial fibrillation (155 male; mean age 63 +/- 11 years) treated with ventricular rate controlling drugs, antiarrhythmic drugs, or without drugs.
At a mean follow-up of 9 months (range 1-24) all patients experienced recurrence of arrhythmia: 48 (14.6%, Group A) suffered Type 1 atrial flutter, and 257 (85.4%, Group B) atrial fibrillation. The relative rate of recurrence of atrial flutter vs atrial fibrillation was similar in patients without treatment or with ventricular rate controlling drugs (from 6.8% to 14.6%, P=ns). However, recurrence was higher (25%) in patients administered antiarrhythmic drug therapy. The relative risk in these patients was 3.02 times greater, compared with patients without treatment, or treated with rate controlling drugs (P<0.001). There were no differences between groups concerning the baseline clinical characteristics and the clinical consequences of the recurrence; patients with atrial flutter had a lower rate of conversion to sinus rhythm (42% vs 64%) and a higher rate of hospital admission (69% vs 36%) compared with those with atrial fibrillation. Six patients (8.5%) experienced 1:1 atrioventricular conduction during atrial flutter with a ventricular rate of 240-280 beats x min(-1).
Our data suggest that the use of antiarrhythmic drugs for the prophylaxis of atrial fibrillation is associated with a threefold increase in the probability of Type 1 atrial flutter recurrence, as opposed to atrial fibrillation, which may have important clinical consequences, but which did not in our study.
为研究服用抗心律失常药物预防心房颤动的患者发生心房颤动转变为心房扑动的比率，我们回顾性分析了305例连续性阵发性心房颤动患者（155例男性；平均年龄63±11岁）的数据，这些患者接受了心室率控制药物、抗心律失常药物治疗或未接受药物治疗。
平均随访9个月（范围1 - 24个月）时，所有患者均出现心律失常复发：48例（14.6%，A组）发生1型心房扑动，257例（85.4%，B组）发生心房颤动。未治疗或接受心室率控制药物治疗的患者中，心房扑动与心房颤动的相对复发率相似（从6.8%至14.6%，P=无显著性差异）。然而，接受抗心律失常药物治疗的患者复发率更高（25%）。与未治疗或接受心率控制药物治疗的患者相比，这些患者的相对风险高3.02倍（P<0.001）。各组之间在基线临床特征和复发的临床后果方面无差异；与心房颤动患者相比，心房扑动患者转为窦性心律的比率较低（42%对64%），住院率较高（69%对36%）。6例患者（8.5%）在心房扑动期间出现1:1房室传导，心室率为240 - 280次/分钟。
我们的数据表明，使用抗心律失常药物预防心房颤动与1型心房扑动复发概率增加三倍相关，与心房颤动相反，这可能具有重要的临床后果，但在我们的研究中并非如此。
