Roy Denis
Research Center, Montreal Heart Institute, Montreal, Quebec, Canada.
Card Electrophysiol Rev. 2003 Sep;7(3):208-10. doi: 10.1023/B:CEPR.0000012383.63580.c8.
Congestive heart failure and atrial fibrillation (AF) are two important and growing problems in medicine and cardiology. Both conditions often coexist and complicate each other's management. Two therapeutic strategies are available for patients with AF and congestive heart failure: the first aims at restoring and maintaining sinus rhythm, whereas the second focuses exclusively on optimizing ventricular rate. Prior studies of AF and congestive heart failure were not randomized and most were retrospective. Although some studies suggested that AF had no effect on survival, in most recent large congestive heart failure trials, AF was reported to be an independent risk factor for mortality or major morbidity. The primary objective of the Atrial Fibrillation in Congestive Heart Failure (AF-CHF) trial is to compare the two widely used treatment strategies with respect to cardiovascular mortality. AF-CHF is a prospective, multicenter trial that will randomize 1450 CHF patients with left ventricular ejection fraction (LVEF) < or =35% and a documented recent episode of atrial fibrillation to either a rhythm control or a rate control strategy. From recent trial data, we anticipate an 18.75% 2-year cardiovascular mortality in the rate control arm and a 25% event reduction in the rhythm control group. As of December 2003, 960 patients have been randomized. Enrollment is expected to be completed in September 2004 with a minimum follow-up of 2 years.
充血性心力衰竭和心房颤动（AF）是医学和心脏病学领域中两个日益严重的重要问题。这两种病症常常并存，且相互影响，使治疗变得复杂。对于患有房颤和充血性心力衰竭的患者，有两种治疗策略：第一种旨在恢复并维持窦性心律，而第二种则仅专注于优化心室率。先前关于房颤和充血性心力衰竭的研究并非随机试验，且大多为回顾性研究。尽管一些研究表明房颤对生存率没有影响，但在最近的大型充血性心力衰竭试验中，房颤被报告为死亡率或主要发病的独立危险因素。充血性心力衰竭合并心房颤动（AF-CHF）试验的主要目的是比较两种广泛使用的治疗策略在心血管死亡率方面的差异。AF-CHF是一项前瞻性、多中心试验，将把1450名左心室射血分数（LVEF）≤35%且有近期房颤发作记录的充血性心力衰竭患者随机分为节律控制组或心率控制组。根据最近的试验数据，我们预计心率控制组的2年心血管死亡率为18.75%，节律控制组的事件发生率降低25%。截至2003年12月，已有960名患者被随机分组。预计招募工作将于2004年9月完成，最少随访2年。
