First Department of Internal Medicine, Medical University Varna; Varna-Bulgaria.
Anatol J Cardiol. 2021 May;25(5):338-345. doi: 10.14744/AnatolJCardiol.2020.80914.
Atrial fibrillation (AF) is a progressive disease, associated with increased risk of mortality, stroke, heart failure, and worsens quality of life. There is a high incidence of AF recurrence despite the treatment. The aim of the study was to assess the time to recurrence of AF after sinus rhythm restoration with electrical or pharmacological cardioversion and to identify the risk factors.
This study included 101 patients with AF (56% females) at a mean age of 68.02±7 years, after sinus rhythm restoration in a clinical observation of 1-year placebo-controlled treatment with spironolactone (1: 1). The patients were analyzed on the basis of AF recurrence, hospitalization, demographic parameters, comorbidities, embolic risk, and value of biomarker galectin-3 (Gal-3).
The average number of AF recurrences was1.62 per patient per year. The median time of occurrence of at least one new episode was 48 days, 95% confidence interval (CI) 14.24-81.76. Female patients experienced significantly more recurrences than male-53.3% vs. 28.6% hazard ration (HR) =1.76, 95% CI 1.02-3.03, p=0.036. The recurrences were more common with increased age, although not significantly. Patients with arterial hypertension had a threefold risk of recurrences than those without hypertension (p=0.025), independently of the treatment. CHA2DS2-VASc score was significantly associated with AF recurrent episodes. Patients with gout had a twofold increased risk, without statistical significance (p=0.15). There was no difference in the AF episodes according to treatment with spironolactone. The levels of Gal-3 did not affect the number of AF recurrences (p=0.9).
AF is associated with frequent recurrences after restoration of sinus rhythm in the majority of the patients. Most of them occurred within the first 3 months. Female sex, arterial hypertension, and CHA2DS2-VASc score were significant predictors of AF recurrence. Spironolactone did not reduce AF recurrences.
心房颤动（AF）是一种进行性疾病，与死亡率、中风、心力衰竭风险增加以及生活质量恶化相关。尽管进行了治疗，但 AF 仍有很高的复发率。本研究旨在评估电复律或药物复律后窦性心律恢复后 AF 复发的时间，并确定相关风险因素。
这项研究纳入了 101 名（56%为女性）AF 患者（平均年龄 68.02±7 岁），在一项为期 1 年的安慰剂对照螺内酯（1:1）临床观察中，窦性心律恢复后进行治疗。根据 AF 复发、住院、人口统计学参数、合并症、栓塞风险和生物标志物半乳糖凝集素-3（Gal-3）值对患者进行分析。
平均每位患者每年发生 AF 复发 1.62 次。至少发生一次新发作的中位时间为 48 天，95%置信区间（CI）为 14.24-81.76。女性患者的复发率显著高于男性（53.3% vs. 28.6%，危险比[HR]=1.76，95%CI 1.02-3.03，p=0.036）。虽然年龄增加与复发相关，但无统计学意义。与无高血压的患者相比，高血压患者的复发风险增加了三倍（p=0.025），且与治疗无关。CHA2DS2-VASc 评分与 AF 复发事件显著相关。痛风患者的复发风险增加了一倍，但无统计学意义（p=0.15）。根据螺内酯治疗，AF 发作次数无差异。Gal-3 水平不影响 AF 复发次数（p=0.9）。
在大多数患者中，窦性心律恢复后，AF 常复发。大多数患者在最初的 3 个月内复发。女性、高血压和 CHA2DS2-VASc 评分是 AF 复发的显著预测因子。螺内酯并不能降低 AF 的复发率。
