Chatterjee Saurav, Sardar Partha, Lichstein Edgar, Mukherjee Debabrata, Aikat Shamik
Preventive Cardiology, Brown University and the Providence VAMC, Providence, RI, USA.
Pacing Clin Electrophysiol. 2013 Jan;36(1):122-33. doi: 10.1111/j.1540-8159.2012.03513.x. Epub 2012 Sep 14.
In patients with atrial fibrillation (AF), ventricular rate control with medications has been found to be noninferior in preventing clinical events, compared to a strategy converting patients to sinus rhythm and maintaining it with medications. Guidelines have accepted rate control as an acceptable therapeutic option. Most of the prior studies excluded patients without significant left ventricular dysfunction, or permanent AF.
The authors searched the PubMed, CENTRAL, and EMBASE databases for randomized controlled trials from 1966 to 2011. Trials included were direct head-to-head comparisons of rate- and rhythm-control strategy using pharmacological means. The primary outcome assessed was risk of all-cause mortality. We also assessed other pooled clinical endpoints using a random effects model (Mantel-Haenszel) between rate and rhythm-control strategies.
Ten studies (total N = 7,867) met inclusion/exclusion criteria. In-hospital mortality was not different between groups (P = 0.31). The rates of stroke, systemic embolism, worsening heart failure, myocardial infarction, and bleeding were also similar. However, rates of rehospitalization were much lower with a rate-control strategy (P = 0.007). An exploratory analysis in patients younger than 65 years revealed a rhythm-control strategy was superior to rate control in the prevention of all-cause mortality (P = 0.0007).
This systematic review suggests no difference in clinical outcomes with a rate or rhythm-control strategy with AF. However, rehospitalization rates appear to be lower with pharmacological rate control for all ages, while finding support for rhythm control in younger patients.
在心房颤动（AF）患者中，与将患者转为窦性心律并通过药物维持的策略相比，药物控制心室率在预防临床事件方面并不逊色。指南已将心率控制作为一种可接受的治疗选择。大多数先前的研究排除了没有明显左心室功能障碍或永久性房颤的患者。
作者检索了1966年至2011年期间PubMed、CENTRAL和EMBASE数据库中的随机对照试验。纳入的试验是使用药物手段对心率控制和节律控制策略进行直接的头对头比较。评估的主要结局是全因死亡率风险。我们还使用随机效应模型（Mantel-Haenszel）评估了心率控制和节律控制策略之间的其他汇总临床终点。
十项研究（总N = 7867）符合纳入/排除标准。两组间住院死亡率无差异（P = 0.31）。中风、全身性栓塞、心力衰竭恶化、心肌梗死和出血的发生率也相似。然而，心率控制策略的再住院率要低得多（P = 0.007）。对65岁以下患者的探索性分析显示，节律控制策略在预防全因死亡率方面优于心率控制（P = 0.0007）。
这项系统评价表明，房颤的心率控制或节律控制策略在临床结局上没有差异。然而，各年龄段药物控制心率的再住院率似乎较低，而年轻患者则支持节律控制。
