Singh Steven N, Poole Jeannie, Anderson Jill, Hellkamp Anne S, Karasik Pamela, Mark Daniel B, Lee Kerry L, Bardy Gust H
Department of Veterans Affairs Medical Center, Washington, DC 20422, USA.
Am Heart J. 2006 Nov;152(5):974.e7-11. doi: 10.1016/j.ahj.2006.08.012.
Heart failure complicated by atrial fibrillation (AF) is associated with excessive mortality and morbidity. The aim of the study was to determine the role of amiodarone or implantable cardioverter/defibrillator (ICD) in patients with AF and heart failure.
Patients were determined to be in sinus rhythm (SR) or AF on the baseline electrocardiogram. Mortality, ICD discharge, or change in rhythm was assessed.
Of the 2521 patients at baseline, 2328 were in SR and 173 were in AF. Overall, after adjusting for differences in baseline variables, there was no difference in mortality between patients with SR and patients with AF (P = .98), nor within assigned groups: placebo (P) (P = .82), amiodarone (A) (P = .68), and ICD (P = .40). For patients with SR, ICD decreased mortality (P vs ICD, P = .004; A vs ICD, P = .004; P vs A, P = .75). For patients with AF, there were no differences in mortality among groups (P vs ICD, P = .99; A vs ICD, P = .88; P vs A, P = .88). Of patients with SR at baseline, 11% (264) developed AF by any electrocardiogram during follow-up (P 12%, A 8%, ICD 15%; A vs P, P = .019; A vs ICD, P = .001; P vs ICD, P = .044). Of patients with AF, 70% (121) developed SR during follow-up (P 66%, A 67%, ICD 75%, all P = not significant against each other). Any ICD shock was seen in 52% (34) of patients with AF vs 30% (222) of patients with SR (P = .001). Inappropriate shocks were seen in 37% (24) of patients with AF vs 14% (107) of patients with SR (P = .001). Appropriate shocks were more often seen in AF vs SR (P = .03).
After adjustments for baseline differences, patients with AF and patients with SR have similar overall mortality rates. Compared to P or A, ICD improves survival in patients with SR, but may not in patients with AF. Amiodarone is effective in reducing new AF, but not in converting AF to SR. Implantable cardioverter/defibrillator, inappropriate, and appropriate shocks were more often seen in AF than in SR.
心力衰竭合并心房颤动（AF）与过高的死亡率和发病率相关。本研究的目的是确定胺碘酮或植入式心脏复律除颤器（ICD）在AF和心力衰竭患者中的作用。
根据基线心电图确定患者处于窦性心律（SR）或AF状态。评估死亡率、ICD放电情况或心律变化。
在2521例基线患者中，2328例处于SR，173例处于AF。总体而言，在对基线变量差异进行调整后，SR患者和AF患者的死亡率没有差异（P = 0.98），在指定组内也无差异：安慰剂组（P）（P = 0.82）、胺碘酮组（A）（P = 0.68）和ICD组（P = 0.40）。对于SR患者，ICD降低了死亡率（P组与ICD组，P = 0.004；A组与ICD组，P = 0.004；P组与A组，P = 0.75）。对于AF患者，各组间死亡率无差异（P组与ICD组，P = 0.99；A组与ICD组，P = 0.88；P组与A组，P = 0.88）。基线时处于SR的患者中，11%（264例）在随访期间通过任何心电图检查出现AF（P组12%，A组8%，ICD组15%；A组与P组，P = 0.019；A组与ICD组，P = 0.001；P组与ICD组，P = 0.044）。AF患者中，70%（121例）在随访期间出现SR（P组66%，A组67%，ICD组75%，各组间相互比较P值均无统计学意义）。AF患者中有52%（34例）出现过ICD电击，而SR患者中这一比例为30%（222例）（P = 0.001）。AF患者中有37%（24例）出现不适当电击，而SR患者中这一比例为14%（107例）（P = 0.001）。AF患者比SR患者更常出现适当电击（P = 0.03）。
在对基线差异进行调整后，AF患者和SR患者的总体死亡率相似。与P或A相比，ICD可提高SR患者的生存率，但对AF患者可能无效。胺碘酮可有效减少新发AF，但不能将AF转复为SR。AF患者比SR患者更常出现植入式心脏复律除颤器、不适当和适当的电击。
