Li Huagui, Riedel Roger, Oldemeyer J Bradley, Rovang Karen, Hee Tom
The Cardiac Center of Creighton University, Omaha, Nebraska 68131, USA.
Am J Cardiol. 2004 Jan 1;93(1):45-8. doi: 10.1016/j.amjcard.2003.09.010.
The AFFIRM investigators have recommended rate control as the preferred strategy for recurrent atrial fibrillation (AF), but the appropriate strategy for new-onset persistent AF is uncertain. Our study evaluated the AF recurrence rate and the impact of rhythm-control drugs (class 1A, 1C, and 3 antiarrhythmic drugs) on patients with new-onset persistent AF after successful direct-current (DC) cardioversion. Consecutive patients who underwent DC cardioversion of AF from January 1, 1996 to December 31, 1999 were screened for new-onset persistent AF, and 150 patients met the inclusion criteria. After the first DC cardioversion, 50 patients received rhythm-control drugs (rhythm-control group) and the other 100 did not (rate-control group). The 2 groups had similar clinical characteristics except for a lower ejection fraction (44 +/- 14% vs 49 +/- 14%, p <0.01) and a higher proportion of idiopathic dilated cardiomyopathy (20% vs 1%, p = 0.03) in the rhythm-control group versus the rate-control group. During the follow-up period there was a trend toward a lower rate of early AF recurrence at 24 hours after DC cardioversion in the rhythm-control group versus the rate-control group (6% vs 16%, p = 0.11), but there was a high recurrence rate of AF in both groups at 1 month (30% for the rhythm-control group vs 41% for the rate-control group, p = 0.25). At the end of the follow-up period, rhythm-control therapy was abandoned in 78% of the rhythm-control group patients after the failure of 1 to 3 rhythm-control drugs. In the rate-control group, rhythm-control therapy was attempted after AF recurrence in 62 patients but was later abandoned in 48 patients (77%) because of treatment failure. Therefore, the high incidence of treatment failure with rhythm-control therapy suggests that rate control with anticoagulation should be preferred in patients with new-onset persistent AF if AF recurs after DC cardioversion.
AFFIRM研究的研究者们推荐将心率控制作为复发性心房颤动（AF）的首选策略，但对于新发持续性AF的合适策略尚不确定。我们的研究评估了AF复发率以及节律控制药物（1A类、1C类和3类抗心律失常药物）对成功直流电（DC）转复后新发持续性AF患者的影响。对1996年1月1日至1999年12月31日期间接受AF的DC转复的连续患者进行筛查以确定新发持续性AF，150例患者符合纳入标准。首次DC转复后，50例患者接受节律控制药物治疗（节律控制组），另外100例未接受（心率控制组）。除了节律控制组的射血分数较低（44±14%对49±14%，p<0.01）以及特发性扩张型心肌病的比例较高（20%对1%，p = 0.03）外，两组具有相似的临床特征。在随访期间，节律控制组与心率控制组相比，DC转复后24小时早期AF复发率有降低趋势（6%对16%，p = 0.11），但两组在1个月时AF复发率均较高（节律控制组为30%，心率控制组为41%，p = 0.25）。在随访期末，节律控制组中78%的患者在1至3种节律控制药物治疗失败后放弃了节律控制治疗。在心率控制组中，62例患者在AF复发后尝试了节律控制治疗，但后来48例患者（77%）因治疗失败而放弃。因此，节律控制治疗的高失败发生率表明，如果新发持续性AF患者在DC转复后AF复发，应首选抗凝的心率控制。
