Research Center, Montreal Heart Institute, 5000 Bélanger Street, Montreal, Quebec, Canada.
J Am Coll Cardiol. 2010 Apr 27;55(17):1796-802. doi: 10.1016/j.jacc.2010.01.023.
The goal of this study was to evaluate the relationship between the presence of sinus rhythm and outcomes in patients with a history of congestive heart failure (CHF) and atrial fibrillation (AF).
The value of sinus rhythm maintenance in patients with AF and heart failure (HF) is uncertain.
A total of 1,376 patients with AF, ejection fraction < or =35%, and heart failure symptoms were randomized to a rhythm- or rate-control strategy. Detailed efficacy analyses were used to evaluate the independent effects of treatment strategy and the presence of sinus rhythm on cardiovascular outcomes.
Overall, 445 (32%) patients died and 402 (29%) experienced worsening HF. The rhythm-control strategy was not predictive of cardiovascular mortality (hazard ratio [HR]: 0.90, 95% confidence interval [CI]: 0.70 to 1.16; p = 0.41), all-cause death (HR: 0.86, 95% CI: 0.69 to 1.08; p = 0.19), or worsening HF (HR: 0.86, 95% CI: 0.68 to 1.10; p = 0.23). In analyses devised to isolate the effect of underlying rhythm, sinus rhythm was not associated with cardiovascular mortality [HR: 1.22, 95% CI: 0.80 to 1.87; p = 0.35), total mortality [HR: 1.11, 95% CI: 0.78 to 1.58; p = 0.57), or worsening HF [HR: 0.62, 95% CI: 0.37 to 1.02; p = 0.059).
A rhythm-control strategy or the presence of sinus rhythm are not associated with better outcomes in patients with AF and CHF.
本研究旨在评估窦性心律与充血性心力衰竭（CHF）和心房颤动（AF）病史患者结局之间的关系。
维持 AF 伴心力衰竭（HF）患者窦性心律的价值尚不确定。
共纳入 1376 例 AF 患者，射血分数≤35%，并伴有心力衰竭症状，随机分为节律或心率控制策略组。采用详细的疗效分析评估治疗策略和窦性心律的存在对心血管结局的独立影响。
共有 445 例（32%）患者死亡，402 例（29%）患者出现 HF 恶化。节律控制策略不能预测心血管死亡率（风险比 [HR]：0.90，95%置信区间 [CI]：0.70 至 1.16；p=0.41）、全因死亡（HR：0.86，95%CI：0.69 至 1.08；p=0.19）或 HF 恶化（HR：0.86，95%CI：0.68 至 1.10；p=0.23）。在旨在分离潜在节律影响的分析中，窦性心律与心血管死亡率（HR：1.22，95%CI：0.80 至 1.87；p=0.35）、总死亡率（HR：1.11，95%CI：0.78 至 1.58；p=0.57）或 HF 恶化（HR：0.62，95%CI：0.37 至 1.02；p=0.059）均无关。
节律控制策略或窦性心律的存在与 AF 合并 CHF 患者的更好结局无关。
