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电复律后选择哪种抗心律失常药物:一项针对非瓣膜性心房颤动患者的研究。

Which antiarrhythmic drug to choose after electrical cardioversion: A study on non-valvular atrial fibrillation patients.

机构信息

Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Division of Cardiology, Department of Medicine, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea.

出版信息

PLoS One. 2018 May 22;13(5):e0197352. doi: 10.1371/journal.pone.0197352. eCollection 2018.

Abstract

The relative efficacy of antiarrhythmic drugs (AADs) after electrical cardioversion are not well established. This study aimed to investigate the efficacies of different AADs for maintaining sinus rhythm (SR) after electrical cardioversion for atrial fibrillation (AF). We selected patients from a retrospective registry including patients admitted for cardioversion between January 2012 and June 2016. The primary outcome was time to AF recurrence during the first year after cardioversion. The secondary outcomes included AF recurrence within 1 month, and first readmission due to heart failure, stroke, or additional non-pharmacological rhythm control. A total of 265 patients were divided into the 4 groups according to AAD type: flecainide (n = 33), propafenone (n = 64), amiodarone (n = 128), and dronedarone (n = 40). During the first year after cardioversion, the AF recurrence-free survival was similar between all AAD groups (69.7% vs. 67.2% vs. 71.9% vs. 80.0%, p = 0.439). About half of all recurrences occurred during the first month. There was no difference in any of the secondary outcomes, although the amiodarone group showed a trend toward more non-pharmacological rhythm control. AAD type was not associated with recurrence in multivariate analysis. In this study, half of all patients received amiodarone after electrical cardioversion. Flecainide, propafenone, amiodarone, and dronedarone showed similar efficacies for maintaining SR after electrical cardioversion. Thus, it might be reasonable to reconsider amiodarone use after cardioversion, since it did not show superior efficacy to the other drugs considered and is associated with potential side effects.

摘要

电复律后抗心律失常药物(AAD)的相对疗效尚未得到很好的确立。本研究旨在探讨不同 AAD 类药物在电复律治疗心房颤动(AF)后维持窦性心律(SR)的疗效。我们从 2012 年 1 月至 2016 年 6 月的回顾性登记中选择了接受电复律的患者。主要结局是电复律后 1 年内 AF 复发的时间。次要结局包括 1 个月内 AF 复发,以及因心力衰竭、中风或其他非药物节律控制再次入院。根据 AAD 类型,将 265 例患者分为 4 组:氟卡尼(n = 33)、普罗帕酮(n = 64)、胺碘酮(n = 128)和决奈达隆(n = 40)。电复律后 1 年内,所有 AAD 组的 AF 无复发生存率相似(69.7%比 67.2%比 71.9%比 80.0%,p = 0.439)。约一半的复发发生在第一个月内。虽然胺碘酮组倾向于更多地进行非药物节律控制,但在任何次要结局上均无差异。多变量分析显示,AAD 类型与复发无关。在这项研究中,一半的患者在电复律后接受了胺碘酮。氟卡尼、普罗帕酮、胺碘酮和决奈达隆在电复律后维持 SR 方面疗效相似。因此,重新考虑电复律后胺碘酮的使用可能是合理的,因为它没有显示出比其他考虑的药物更优越的疗效,并且与潜在的副作用相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/93dc/5963785/b5b78fe20868/pone.0197352.g001.jpg

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