Dorian Paul, Mangat Iqwal
St. Michael's Hospital, Toronto, ON, Canada.
Card Electrophysiol Rev. 2003 Sep;7(3):276-9. doi: 10.1023/B:CEPR.0000012395.33292.cd.
Many patients with atrial fibrillation develop symptoms attributable to the cardiac arrhythmia itself. These symptoms may be improved either by restoring sinus rhythm or by controlling the rapid and irregular ventricular response that often accompanies this arrhythmia. One of the principal goals of therapy of atrial fibrillation management is improvement of patient symptoms; it is important to quantify these symptoms by some form of quality of life analysis. The Canadian Trial of Atrial Fibrillation (CTAF) was a multi-centre randomized clinical trial of amiodarone compared with either propafenone or sotalol in patients with recent atrial fibrillation. The quality of life (QOL) substudy of CTAF was a prospective, comprehensive assessment of quality of life of patients enrolled in CTAF. Summary measures of physical and mental health on the generic QOL scale (SF-36) improved significantly with treatment from baseline to 3 months (41.9 +/- 9.6 to 43.7 +/- 9.2, p = 0.001 for the physical component and 47.5 +/- 10.4 to 49.0 +/- 9.8, p = 0.023 for the mental component). On an arrhythmia specific scale (SCL), a significant and larger improvement was noted from baseline to 3 months in both arrhythmia symptom frequency and severity (symptom frequency from 20.4 +/- 9.4 to 16.2 +/- 9.5, symptom severity from 16.7 +/- 8.2 to 12.9 +/- 7.6, both p < 0.001). The quality of life improvements were similar in the amiodarone group compared to the sotalol or propafenone groups, both for the SF-36 and the disease-specific symptom checklist (SCL) measures. In contrast, an atrial fibrillation severity scale (AFSS) did show differences between the assigned drug therapies, which were associated with different rates of arrhythmia recurrence in the parent study. By 3 months global well-being was significantly worse for patients who had recurrent atrial fibrillation compared to those who did not (6.9 +/- 1.8 versus 7.4 +/- 1.8, p = 0.04). Similarly, symptom severity at 3 months was 11.8 +/- 7.4 for patients without recurrence, compared to 14.8 +/- 7.4 for those with recurrence ( p = 0.001). Interestingly, none of the usual clinical variables that might be perceived to be associated with quality of life, e.g., male versus female sex, age, NYHA class, beta blocker use, and ejection fraction, had much impact on subjective quality of life measures. Quality of life improves with treatment atrial fibrillation and at least some of these improvements are related to the restoration and maintenance of sinus rhythm.
许多房颤患者会出现可归因于心律失常本身的症状。恢复窦性心律或控制常伴随这种心律失常的快速且不规则的心室反应，都可能改善这些症状。房颤治疗的主要目标之一是改善患者症状；通过某种形式的生活质量分析来量化这些症状很重要。加拿大房颤试验（CTAF）是一项多中心随机临床试验，比较了胺碘酮与普罗帕酮或索他洛尔对近期房颤患者的疗效。CTAF的生活质量（QOL）子研究是对CTAF入选患者生活质量的前瞻性综合评估。在一般生活质量量表（SF - 36）上，从基线到3个月，身体和心理健康的综合测量指标有显著改善（身体部分从41.9±9.6改善到43.7±9.2，p = 0.001；心理部分从47.5±10.4改善到49.0±9.8，p = 0.023）。在心律失常特异性量表（SCL）上，从基线到3个月，心律失常症状频率和严重程度均有显著且更大的改善（症状频率从20.4±9.4降至16.2±9.5，症状严重程度从16.7±8.2降至12.9±7.6，p均<0.001）。对于SF - 36和疾病特异性症状清单（SCL）测量，胺碘酮组与索他洛尔组或普罗帕酮组的生活质量改善相似。相比之下，房颤严重程度量表（AFSS）在不同药物治疗组间确实显示出差异，这与原研究中心律失常复发率不同有关。到3个月时，房颤复发患者的总体幸福感明显低于未复发患者（6.9±1.8对7.4±1.8，p = 0.04）。同样，无复发患者3个月时的症状严重程度为11.8±7.4，而复发患者为14.8±7.4（p = 0.001）。有趣的是，一些通常被认为与生活质量相关的临床变量，如性别、年龄、纽约心脏协会（NYHA）分级、β受体阻滞剂使用情况和射血分数，对主观生活质量测量的影响不大。房颤治疗可改善生活质量，且这些改善至少部分与窦性心律的恢复和维持有关。
