Arrhythmia Division, Spanish Society of Emergency Medicine (SEMES), Madrid.
Emergency Department, Hospital Universitario Severo Ochoa and Universidad Alfonso X, Madrid.
Acad Emerg Med. 2019 Sep;26(9):1034-1043. doi: 10.1111/acem.13703. Epub 2019 Mar 6.
Although rhythm control has failed to demonstrate long-term benefits over rate control in longstanding episodes of atrial fibrillation (AF), there is little evidence concerning recent-onset ones. We analyzed the benefits of rhythm and rate control in terms of symptoms alleviation and need for hospital admission in patients with recent-onset AF.
This was a multicenter, observational, cross-sectional study with prospective standardized data collection carried out in 124 emergency departments (EDs). Clinical variables, treatment effectiveness, and outcomes (control of symptoms, final disposition) were analyzed in stable patients with recent-onset AF consulting for AF-related symptoms.
Of 421 patients included, rhythm control was chosen in 352 patients (83.6%), a global effectiveness of 84%. Rate control was performed in 69 patients (16.4%) and was achieved in 67 (97%) of them. Control of symptoms was achieved in 396 (94.1%) patients and was associated with a heart rate after treatment ≤ 110 beats/min (odds ratio [OR] = 14.346, 95% confidence interval [CI] = 3.90 to 52.70, p < 0.001) and a rhythm control strategy (OR = 2.78, 95% CI = 1.02 to 7.61, p = 0.046). Sixty patients (14.2%) were admitted: discharge was associated with a rhythm control strategy (OR = 2.22, 95% CI = 1.20-4.60, p = 0.031) and admission was associated with a heart rate > 110 beats/min after treatment (OR = 29.71, 95% CI = 7.19 to 123.07, p < 0.001) and acute heart failure (OR = 9.45, 95% CI = 2.91 to 30.65, p < 0.001).
In our study, recent-onset AF patients in whom rhythm control was attempted in the ED had a high rate of symptoms' alleviation and a reduced rate of hospital admissions.
尽管节律控制未能在持续性心房颤动（AF）发作中显示出优于心率控制的长期益处，但关于近期发作的证据很少。我们分析了节律和心率控制在缓解症状和近期发作 AF 患者住院需求方面的益处。
这是一项多中心、观察性、前瞻性、横断面研究，在 124 个急诊科进行了标准化数据收集。对因 AF 相关症状就诊的近期发作 AF 稳定患者进行临床变量、治疗效果和结局（症状控制、最终处置）分析。
在纳入的 421 例患者中，352 例（83.6%）选择节律控制，总体有效率为 84%。69 例（16.4%）进行了心率控制，其中 67 例（97%）达到了目标。396 例（94.1%）患者症状得到控制，与治疗后心率≤110 次/分相关（比值比[OR] = 14.346，95%置信区间[CI] = 3.90 至 52.70，p < 0.001）和节律控制策略（OR = 2.78，95% CI = 1.02 至 7.61，p = 0.046）。60 例（14.2%）患者住院，出院与节律控制策略相关（OR = 2.22，95% CI = 1.20 至 4.60，p = 0.031），住院与治疗后心率>110 次/分（OR = 29.71，95% CI = 7.19 至 123.07，p < 0.001）和急性心力衰竭（OR = 9.45，95% CI = 2.91 至 30.65，p < 0.001）相关。
在我们的研究中，急诊科尝试节律控制的近期发作 AF 患者症状缓解率高，住院率降低。
