Department of Cardiology, University of Groningen University Medical Centre Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
Department of Cardiology, Amphia Hospital, Breda, The Netherlands.
Eur Heart J. 2018 Aug 21;39(32):2987-2996. doi: 10.1093/eurheartj/ehx739.
Atrial fibrillation (AF) is a progressive disease. Targeted therapy of underlying conditions refers to interventions aiming to modify risk factors in order to prevent AF. We hypothesised that targeted therapy of underlying conditions improves sinus rhythm maintenance in patients with persistent AF.
We randomized patients with early persistent AF and mild-to-moderate heart failure (HF) to targeted therapy of underlying conditions or conventional therapy. Both groups received causal treatment of AF and HF, and rhythm control therapy. In the intervention group, on top of that, four therapies were started: (i) mineralocorticoid receptor antagonists (MRAs), (ii) statins, (iii) angiotensin converting enzyme inhibitors and/or receptor blockers, and (iv) cardiac rehabilitation including physical activity, dietary restrictions, and counselling. The primary endpoint was sinus rhythm at 1 year during 7 days of Holter monitoring. Of 245 patients, 119 were randomized to targeted and 126 to conventional therapy. The intervention led to a contrast in MRA (101 [85%] vs. 5 [4%] patients, P < 0.001) and statin use (111 [93%] vs. 61 [48%], P < 0.001). Angiotensin converting enzyme inhibitors/angiotensin receptor blockers were not different. Cardiac rehabilitation was completed in 109 (92%) patients. Underlying conditions were more successfully treated in the intervention group. At 1 year, sinus rhythm was present in 89 (75%) patients in the intervention vs. 79 (63%) in the conventional group (odds ratio 1.765, lower limit of 95% confidence interval 1.021, P = 0.042).
RACE 3 confirms that targeted therapy of underlying conditions improves sinus rhythm maintenance in patients with persistent AF.
Clinicaltrials.gov NCT00877643.
心房颤动（AF）是一种进行性疾病。针对潜在疾病的靶向治疗是指旨在改变风险因素以预防 AF 的干预措施。我们假设针对潜在疾病的靶向治疗可改善持续性 AF 患者的窦律维持。
我们将早期持续性 AF 伴轻度至中度心力衰竭（HF）的患者随机分为针对潜在疾病的靶向治疗组或常规治疗组。两组均接受 AF 和 HF 的因果治疗和节律控制治疗。在此基础上，干预组还开始了四项治疗：（i）盐皮质激素受体拮抗剂（MRAs），（ii）他汀类药物，（iii）血管紧张素转换酶抑制剂和/或受体阻滞剂，以及（iv）包括体力活动、饮食限制和咨询在内的心脏康复。主要终点是在 7 天动态心电图监测期间 1 年时的窦性节律。在 245 名患者中，119 名随机分配至靶向治疗组，126 名随机分配至常规治疗组。干预导致 MRA（101 [85%] vs. 5 [4%]，P < 0.001）和他汀类药物使用率（111 [93%] vs. 61 [48%]，P < 0.001）方面存在差异。血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂无差异。109 名（92%）患者完成了心脏康复。干预组的潜在疾病治疗更成功。1 年后，干预组 89 名（75%）患者窦性节律存在，常规组 79 名（63%）患者窦性节律存在（比值比 1.765，95%置信区间下限 1.021，P = 0.042）。
RACE 3 证实针对潜在疾病的靶向治疗可改善持续性 AF 患者的窦律维持。
Clinicaltrials.gov NCT00877643。
