Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
JACC Clin Electrophysiol. 2019 May;5(5):618-625. doi: 10.1016/j.jacep.2019.01.005. Epub 2019 Feb 27.
This study hypothesized that atrial fibrillation was associated with heart failure (HF) hospitalization, and that patients who received rhythm control therapy had a lower incidence of HF hospitalization and mortality.
Atrial fibrillation is a known risk factor for HF hospitalization and mortality in patients with acquired heart disease. Although atrial arrhythmias are common in adults with tetralogy of Fallot (TOF), data about prevalence and outcomes of therapy for atrial fibrillation are very limited.
The MACHD (Mayo Adult Congenital Heart Disease) database was queried for adults with repaired TOF and documented atrial fibrillation from 1990 to 2017. Primary endpoint was HF hospitalization defined as admission for volume overload (pulmonary congestion and/or peripheral edema) requiring intravenous diuretics. Secondary endpoint was the effect of rhythm control therapy on HF hospitalization and all-cause mortality. Patients were divided into rhythm control and rate control groups based on the therapy initiated at the time of arrhythmia diagnosis.
Of 415 patients, 27 (7%) had 42 HF hospitalizations. Of these 415 patients, 88 (21%) had atrial fibrillation at age 49 ± 13 years. Atrial fibrillation was an independent risk factor for HF hospitalization (adjusted hazard ratio: 2.67; 95% confidence interval: 1.04 to 7.34; p = 0.045). The 88 patients were divided into the rhythm control group (n = 61, 69%) and the rate control group (n = 27, 31%). The rate control group had higher unadjusted annual incidence of HF hospitalization (13% vs. 3%; p = 0.001) and all-cause mortality (11% vs. 4%; p = 0.002).
Atrial fibrillation was a risk factor for HF hospitalization and mortality in TOF patients, and rhythm control therapy was protective against these adverse events.
本研究假设心房颤动与心力衰竭（HF）住院相关，并且接受节律控制治疗的患者 HF 住院和死亡率较低。
心房颤动是获得性心脏病患者 HF 住院和死亡率的已知危险因素。尽管心房心律失常在法洛四联症（TOF）成人中很常见，但关于心房颤动的患病率和治疗结果的数据非常有限。
从 1990 年至 2017 年，在 Mayo 成人先天性心脏病（MACHD）数据库中查询了接受过修复的 TOF 并记录有房性心律失常的成年人。主要终点是 HF 住院定义为因容量超负荷（肺充血和/或外周水肿）需要静脉利尿剂而入院。次要终点是节律控制治疗对 HF 住院和全因死亡率的影响。根据心律失常诊断时开始的治疗方法，将患者分为节律控制组和心率控制组。
在 415 例患者中，有 27 例（7%）发生 42 例 HF 住院。在这 415 例患者中，88 例（21%）在 49 ± 13 岁时发生心房颤动。心房颤动是 HF 住院的独立危险因素（调整后的危险比：2.67；95%置信区间：1.04 至 7.34；p = 0.045）。88 例患者分为节律控制组（n = 61，69%）和心率控制组（n = 27，31%）。心率控制组 HF 住院的未调整年发生率较高（13% vs. 3%；p = 0.001）和全因死亡率（11% vs. 4%；p = 0.002）。
心房颤动是 TOF 患者 HF 住院和死亡的危险因素，节律控制治疗可预防这些不良事件。
