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近期发生心房颤动患者的早期或延迟复律
Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation


Nikki A.H.A. Pluymaekers ... 心脑血管疾病 • 2019.04.18
相关阅读
• 急诊科可否安全延迟新发房颤患者的心脏复律 • 心房颤动患者心脏复律时的抗凝治疗步入新阶段

摘要


背景

近期发生心房颤动的患者通常通过药物复律或电复律的方式立即恢复窦性心律。然而,窦性心律是否需要立即恢复尚不清楚,因为心房颤动往往会自行终止。

 

方法

在一项多中心、随机、开放标签、非劣效性试验中,我们将血流动力学稳定、近期发生(<36小时)有症状心房颤动的急诊患者随机分组,分别接受观察等待疗法(延迟复律组)或早期复律。观察等待疗法指的是仅使用心率控制药物进行初步治疗,如果心房颤动在48小时内未缓解,则采用延迟复律。主要终点是4周时的窦性心律。如果主要终点组间差异的95%置信区间下限大于-10个百分点,则证实非劣效性。

 

结果

4周时,延迟复律组212例患者中的193例(91%)和早期复律组215例患者中的202例(94%)为窦性心律(组间差异,-2.9个百分点;95%置信区间[CI],-8.2~2.2;对于非劣效性,P=0.005)。在延迟复律组中,218例患者中的150例(69%)在48小时内自发转复为窦性心律,61例(28%)在延迟复律后转复为窦性心律。在早期复律组中,219例患者中的36例(16%)在开始复律前转复为窦性心律,171例(78%)在复律后转复为窦性心律。在4周随访期间完成远程监测的患者中,延迟复律组164例患者中的49例(30%)和早期复律组171例患者中的50例(29%)有心房颤动复发。在随机分组后4周内,两组分别有10例患者和8例患者出现了心血管并发症。

 

结论

在近期发生有症状心房颤动的急诊患者中,在4周时恢复窦性心律方面,观察等待疗法不劣于早期复律(由荷兰健康研究和开发组织[Netherlands Organization for Health Research and Development]等资助;RACE 7 ACWAS在ClinicalTrials.gov注册号为NCT02248753)。





作者信息

Nikki A.H.A. Pluymaekers, M.D., Elton A.M.P. Dudink, M.D., Ph.D., Justin G.L.M. Luermans, M.D., Ph.D., Joan G. Meeder, M.D., Ph.D., Timo Lenderink, M.D., Ph.D., Jos Widdershoven, M.D., Ph.D., Jeroen J.J. Bucx, M.D., Ph.D., Michiel Rienstra, M.D., Ph.D., Otto Kamp, M.D., Ph.D., Jurren M. Van Opstal, M.D., Ph.D., Marco Alings, M.D., Ph.D., Anton Oomen, M.D., Charles J. Kirchhof, M.D., Ph.D., Vincent F. Van Dijk, M.D., Hemanth Ramanna, M.D., Ph.D., Anho Liem, M.D., Ph.D., Lukas R. Dekker, M.D., Ph.D., Brigitte A.B. Essers, Ph.D., Jan G.P. Tijssen, Ph.D., Isabelle C. Van Gelder, M.D., Ph.D., and Harry J.G.M. Crijns, M.D., Ph.D. for the RACE 7 ACWAS Investigators*
From the Departments of Cardiology (N.A.H.A.P., E.A.M.P.D., J.G.L.M.L., H.J.G.M.C.) and Clinical Epidemiology and Medical Technology Assessment (B.A.B.E.), the Cardiovascular Research Institute Maastricht (N.A.H.A.P., E.A.M.P.D., J.G.L.M.L., H.J.G.M.C.), Maastricht University Medical Center, Maastricht, VieCuri Medical Center Noord-Limburg, Venlo (J.G.M.), Zuyderland Medical Center, Heerlen (T.L.), Elisabeth-TweeSteden Hospital, Tilburg (J.W.), Diakonessen Hospital, Utrecht (J.J.J.B.), University of Groningen, Groningen (M.R., I.C.V.G.), VU University Medical Center Amsterdam (O.K.) and Academic Medical Center (J.G.P.T), Amsterdam, Medical Spectrum Twente, Enschede (J.M.V.O.), Amphia Hospital, Breda (M.A.), Antonius Hospital, Sneek (A.O.), Alrijne Hospital, Leiderdorp (C.J.K.), St. Antonius Hospital, Nieuwegein (V.F.V.D.), Haga Teaching Hospital, The Hague (H.R.), St. Franciscus Gasthuis, Rotterdam (A.L.), and Catharina Hospital, Eindhoven (L.R.D) — all in the Netherlands. Address reprint requests to Dr. Crijns at the Department of Cardiology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands, or at hjgm.crijns@mumc.nl. *A complete list of investigators in the RACE 7 ACWAS trial is provided in the Supplementary Appendix, available at NEJM.org.

 

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