Friberg Leif, Hammar Niklas, Pettersson Hans, Rosenqvist Mårten
Department of Clinical Science and Education, Karolinska Institute at South Hospital, Stockholm, Sweden.
Eur Heart J. 2007 Oct;28(19):2346-53. doi: 10.1093/eurheartj/ehm308. Epub 2007 Aug 1.
Whether paroxysmal atrial fibrillation (PxAF) affects survival is poorly recognized. Results have been conflicting in the few previously published studies. To describe mortality in patients with PxAF and to identify risk factors amenable to treatment.
All patients (n=2824) treated for atrial fibrillation during 2002 at one of Scandinavia's largest hospitals were followed prospectively for a mean of 4.6 years. Information about type of AF, comorbidity, and medication was acquired from medical records and national registers. Information about deaths was obtained from the National Cause of Death Register. One-third (n=888) of the patients had PxAF (mean age 73 years). During follow-up, 267 of them died. The mean annual mortality rate was 7%. Compared with the general population, the standardized mortality ratio (SMR) was 1.6 (95% CI 1.4-1.8) for all-cause mortality, 2.4 (95% CI 1.4-3.7) for death from myocardial infarction, and 2.6 (95% CI 1.3-5.2) for death from heart failure. Warfarin treatment was associated with improved survival both in comparison with the general population (SMR 1.1 with warfarin, SMR 2.2 without warfarin) and after propensity score matching for odds to receive warfarin (HR 0.5, 95% CI 0.3-0.9). The improvement of survival could not be explained by stroke reduction alone.
PxAF is associated with increased mortality, which mostly appears to be related to concomitant cardiovascular risks. Treatment with warfarin is associated with improved survival in PxAF patients.
阵发性心房颤动（PxAF）是否影响生存率尚未得到充分认识。在先前发表的少数研究中，结果相互矛盾。旨在描述PxAF患者的死亡率，并确定可治疗的危险因素。
对2002年在斯堪的纳维亚最大的医院之一接受心房颤动治疗的所有患者（n = 2824）进行了平均4.6年的前瞻性随访。从医疗记录和国家登记处获取有关房颤类型、合并症和用药情况的信息。从国家死亡原因登记处获得死亡信息。三分之一（n = 888）的患者患有PxAF（平均年龄73岁）。在随访期间，其中267人死亡。年平均死亡率为7%。与普通人群相比，全因死亡率的标准化死亡率（SMR）为1.6（95%CI 1.4 - 1.8），心肌梗死死亡的SMR为2.4（95%CI 1.4 - 3.7），心力衰竭死亡的SMR为2.6（95%CI 1.3 - 5.2）。与普通人群相比，华法林治疗与生存率提高相关（使用华法林时SMR为1.1，未使用华法林时SMR为2.2），并且在倾向评分匹配接受华法林的几率后也是如此（HR 0.5，95%CI 0.3 - 0.9）。生存率的提高不能仅通过降低中风来解释。
PxAF与死亡率增加相关，这主要似乎与伴随的心血管风险有关。华法林治疗与PxAF患者生存率提高相关。
