Wyse D G, Love J C, Yao Q, Carlson M D, Cassidy P, Greene L H, Martins J B, Ocampo C, Raitt M H, Schron E, Stamato N J, Olarte A
Division of Cardiology, University of Calgary, Calgary, Canada.
J Interv Card Electrophysiol. 2001 Sep;5(3):267-73. doi: 10.1023/a:1011460631369.
Emerging evidence suggests that atrial fibrillation is not a benign arrhythmia. It is associated with increased risk of death. The magnitude of association is controversial and potential causes remain unknown. Patients in the registry of the Antiarrhythmics Versus Implantable Defibrillators (AVID) Trial form the basis for this report. Baseline variables, in particular the presence or absence of a history of atrial fibrillation/flutter, were examined in relation to survival. Multivariate Cox regression was used to adjust for differences in important baseline co-variables using 27 pre-selected variables. There were 3762 subjects who were followed for an average of 773+/-420 days; 1459 (39 %) qualified with ventricular fibrillation and 2303 (61 %) with ventricular tachycardia. A history of atrial fibrillation/flutter was present in 24.4 percent. There were many differences in baseline variables between those with and those without a history of atrial fibrillation/flutter. After adjustment for baseline differences, a history of atrial fibrillation/flutter remained a significant independent predictor of mortality, (relative risk=1.20; 95 % confidence intervals=1.03-1.40; p=0.020). Antiarrhythmic drug use, other than amiodarone or sotalol, was also a significant independent predictor of mortality (relative risk 1.34; 95 % confidence intervals 1.07-1.69, p=0.011. Atrial fibrillation/flutter is a significant independent risk factor for increased mortality in patients presenting with ventricular tachyarrhythmias. This risk may have been overestimated in previous studies that could not adjust for the proarrhythmic effects of antiarrhythmic drugs other than amiodarone or sotalol.
新出现的证据表明，心房颤动并非一种良性心律失常。它与死亡风险增加相关。这种关联的程度存在争议，潜在原因仍不明确。抗心律失常药物与植入式除颤器（AVID）试验登记中的患者构成了本报告的基础。研究了基线变量，特别是心房颤动/扑动病史的有无与生存率的关系。使用多变量Cox回归，通过27个预先选定的变量来调整重要基线协变量的差异。共有3762名受试者，平均随访773±420天；1459名（39%）符合室颤标准，2303名（61%）符合室性心动过速标准。有24.4%的患者有心房颤动/扑动病史。有心房颤动/扑动病史和无心房颤动/扑动病史的患者在基线变量上存在许多差异。在调整基线差异后，心房颤动/扑动病史仍然是死亡率的一个显著独立预测因素（相对风险=1.20；95%置信区间=1.03 - 1.40；p = 0.020）。除胺碘酮或索他洛尔外，使用抗心律失常药物也是死亡率的一个显著独立预测因素（相对风险1.34；95%置信区间1.07 - 1.69，p = 0.011）。心房颤动/扑动是室性快速性心律失常患者死亡率增加的一个显著独立危险因素。在之前无法调整除胺碘酮或索他洛尔以外的抗心律失常药物的促心律失常作用的研究中，这种风险可能被高估了。
