Cardiovascular Center, Division of Cardiology, Seoul National University Bundang Hospital, Gumiro 166, Bundang, Seongnam, Republic of Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
ESC Heart Fail. 2021 Aug;8(4):2816-2825. doi: 10.1002/ehf2.13354. Epub 2021 May 6.
Tachycardia is a reversible event that may cause hemodynamic decompensation but may not necessarily cause direct damages to the myocardium. To evaluate the clinical outcomes of patients with heart failure (HF) and atrial fibrillation (AF), whose acute decompensation was tachycardia mediated.
The Korean Acute Heart Failure registry was a prospective registry that consecutively enrolled 5625 patients with acute HF. Patients were classified into three groups according to the rhythm and aggravating factor: (i) 3664 (65.1%) patients with sinus rhythm (SR), (ii) 1033 (18.4%) patients with AF whose decompensation was tachycardia-mediated, AF-TM (+), and (iii) N = 928 (16.5%) patients with AF whose decompensation was not tachycardia-mediated, AF-TM (-). The primary outcomes were in-hospital and post-discharge 1 year all-cause mortality. At admission, the mean heart rate was 90.8 ± 23.4, 86.8 ± 26.8, and 106.3 ± 29.7 beats per minute for the SR, AF-TM (-), and AF-TM (+) groups, respectively. The AF-TM (+) group had more favourable characteristics such as de novo onset HF, less diabetes, ischaemic heart disease, and higher blood pressure than the AF-TM (-) group. In-hospital mortality rates were 5.1%, 6.5%, and 1.7% for SR, AF-TM (-), and AF-TM (+) groups, respectively. In logistic regression analysis, the AF-TM (+) group had lower in-hospital mortality after adjusting the significant covariates (odds ratio, 0.49; 95% confidence interval, 0.26-0.93). The mortality rate did not differ between SR and AF-TM (-) groups. During 1 year follow-up, 990 (18.5%) patients died. In univariate and multivariate Cox proportional regression analyses, there was no difference in 1-year all-cause mortality between the three groups.
In patients with HF and AF, patients whose acute decompensation is tachycardia-mediated have better in-hospital, but similar post-discharge outcomes compared with those with SR or those with AF whose decompensation is not tachycardia-mediated.
ClinicalTrial.gov NCT01389843.
心动过速是一种可能导致血液动力学失代偿但不一定导致心肌直接损伤的可逆事件。本研究旨在评估急性失代偿性心动过速介导的心力衰竭（HF）和心房颤动（AF）患者的临床结局。
韩国急性心力衰竭注册研究是一项前瞻性注册研究，连续纳入了 5625 例急性 HF 患者。根据节律和加重因素将患者分为三组：（i）窦性节律（SR）组 3664 例（65.1%），（ii）AF 组 1033 例（18.4%），其中急性失代偿性心动过速为 AF-TM（+），（iii）AF 组 928 例（16.5%），急性失代偿性心动过速为 AF-TM（-）。主要终点为住院期间和出院后 1 年全因死亡率。入院时，SR、AF-TM（-）和 AF-TM（+）组的平均心率分别为 90.8±23.4、86.8±26.8 和 106.3±29.7 次/分。与 AF-TM（-）组相比，AF-TM（+）组具有更多有利的特征，如新发 HF、糖尿病、缺血性心脏病和更高的血压。SR、AF-TM（-）和 AF-TM（+）组的住院死亡率分别为 5.1%、6.5%和 1.7%。在调整了显著协变量后，logistic 回归分析显示 AF-TM（+）组的住院死亡率较低（比值比，0.49；95%置信区间，0.26-0.93）。SR 组和 AF-TM（-）组的死亡率无差异。在 1 年随访期间，990 例（18.5%）患者死亡。单因素和多因素 Cox 比例风险回归分析显示，三组之间 1 年全因死亡率无差异。
在 HF 和 AF 患者中，急性失代偿性心动过速介导的患者的住院期间结局较好，但与窦性节律或非心动过速介导的 AF 患者的出院后结局相似。
ClinicalTrials.gov NCT01389843。
