Suzuki Shinya, Yamashita Takeshi, Otsuka Takayuki, Sagara Koichi, Uejima Tokuhisa, Oikawa Yuji, Yajima Junji, Koike Akira, Nagashima Kazuyuki, Kirigaya Hajime, Ogasawara Ken, Sawada Hitoshi, Yamazaki Tsutomu, Aizawa Tadanori
Department of Clinical Epidemiology & Systems, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
Heart Vessels. 2009 Jul;24(4):287-93. doi: 10.1007/s00380-008-1121-2. Epub 2009 Jul 22.
Many large-scale randomized control trials (RCTs) have been performed regarding treatment strategy in atrial fibrillation (AF) in Western countries and also in Japan. However, limited data are available concerning real-world relationships between the treatment strategy and prognosis of AF patients. Out of a prospective cohort of The Shinken Database 2004 (n = 2 412), 286 AF patients (male 205, 64.1 +/- 12.3 years, paroxysmal form 165) were retrospectively investigated. The percentage of AF patients under the rhythm control strategy was evaluated using the Kaplan-Meier method, which showed the cumulative proportion of rhythm control strategy was approximately 30% at the 90th day after the initial visit and 40.0% at 1 year. The average time to the first rhythm control strategy was 68.3 +/- 106.7 days. Those under rhythm control strategy were associated with fewer coexisting organic cardiac diseases, a younger age, and smaller left atrial dimension. Consequently, they showed very good prognosis (cumulative incidence rate of cardiovascular events at 1 year was 0.0%). Careful induction of rhythm control strategy, which was adopted in approximately 40% of the patients in the real world, was associated with fewer comorbidities and therefore might lead to better prognosis, although this does not mean the direct effects of rhythm control strategy.
在西方国家以及日本，已经开展了许多关于心房颤动（AF）治疗策略的大规模随机对照试验（RCT）。然而，关于AF患者治疗策略与预后之间的真实世界关系的数据有限。在2004年新研数据库的前瞻性队列研究（n = 2412）中，对286例AF患者（男性205例，年龄64.1±12.3岁，阵发性165例）进行了回顾性调查。采用Kaplan-Meier方法评估接受节律控制策略的AF患者百分比，结果显示，在初次就诊后第90天，节律控制策略的累积比例约为30%，1年时为40.0%。首次采用节律控制策略的平均时间为68.3±106.7天。接受节律控制策略的患者合并器质性心脏病较少、年龄较轻且左心房内径较小。因此，他们显示出非常好的预后（1年时心血管事件的累积发生率为0.0%）。在现实世界中，约40%的患者采用了谨慎的节律控制策略诱导，这与较少的合并症相关，因此可能导致更好的预后，尽管这并不意味着节律控制策略的直接效果。
