UCL Institute of Health Informatics Research, University College London, 222 Euston Rd, London NW1 2DA, UK.
Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.
Europace. 2023 Feb 16;25(2):351-359. doi: 10.1093/europace/euac155.
Utilizing real-world UK data, we aimed to understand: (i) whether anti-arrhythmic drugs and catheter ablation are effective in improving the survival of atrial fibrillation (AF) patients and (ii) which rhythm control option produces better results for the whole AF population and for specific groups of patients, stratified by age, sex, and history of heart failure.
We identified 199 433 individuals (mean age at diagnosis 75.7 ± 12.7 years; 50.2% women) with new-onset AF diagnosis in nationwide electronic health records linking primary care consultation with hospital data and death registry data from 1998 to 2016. We investigated the survival and causes of death of new-onset AF patients receiving vs. not-receiving rhythm control therapies. During a median follow-up of 2.7 (0.7-6.0) years, we observed a significantly lower mortality in patients receiving rhythm control [multivariate-adjusted hazard ratio (HR) = 0.86, 95% confidence interval (CI) 0.84-0.88]. Pulmonary vein isolation was associated with a two-third significant mortality reduction compared with no rhythm control (HR = 0.36, 95% CI 0.28-0.48), flecainide with 50% reduction (HR = 0.52, 95% CI 0.48-0.57), and propafenone and sotalol with reduction by a third (HR = 0.63, 95% CI 0.50-0.81, 0.71, 95% CI 0.68-0.74, respectively). Amiodarone showed no survival benefit in individuals <70 years (HR = 0.99, 95% CI 0.97-1.02). Otherwise, the effect of rhythm control on survival did not differ by age, sex, nor history of heart failure.
Among individuals with new-onset AF, favourable survival was observed for patients receiving rhythm control treatment. Among different rhythm control strategies, pulmonary vein isolation showed the most pronounced survival benefit.
利用英国真实世界数据，我们旨在了解：（i）抗心律失常药物和导管消融是否能有效改善房颤（AF）患者的生存率，以及（ii）对于整个 AF 人群以及年龄、性别和心力衰竭史分层的特定患者群体，哪种节律控制选择产生更好的结果。
我们在全国范围内的电子健康记录中识别了 199433 名新诊断为 AF 的个体（诊断时的平均年龄为 75.7 ± 12.7 岁；50.2%为女性），这些个体的初级保健咨询与医院数据以及 1998 年至 2016 年的死亡登记数据相关联。我们调查了接受与不接受节律控制治疗的新发 AF 患者的生存率和死亡原因。在中位数为 2.7（0.7-6.0）年的随访期间，我们观察到接受节律控制治疗的患者死亡率显著降低[多变量调整后的危险比（HR）=0.86，95%置信区间（CI）0.84-0.88]。与无节律控制相比，肺静脉隔离与死亡率降低三分之二相关（HR=0.36，95%CI 0.28-0.48），氟卡尼降低 50%（HR=0.52，95%CI 0.48-0.57），普罗帕酮和索他洛尔降低三分之一（HR=0.63，95%CI 0.50-0.81，0.71，95%CI 0.68-0.74）。胺碘酮在<70 岁的个体中没有生存获益（HR=0.99，95%CI 0.97-1.02）。否则，节律控制对生存的影响不因年龄、性别或心力衰竭史而异。
在新发 AF 患者中，接受节律控制治疗的患者生存率较好。在不同的节律控制策略中，肺静脉隔离显示出最显著的生存获益。
