挪威奥斯陆大学Dan Atar团队研究了新诊断非瓣膜性房颤患者接受心脏复律的临床预后。相关论文于2021年10月27日发表在《英国医学杂志》上。
为了在最近发生的非瓣膜性心房颤动的大数据集中，比较接受过复律与未复律患者的临床预后，研究组使用前瞻性收集的注册数据进行了一项观察性研究。涉及35个国家的1317个机构，52057名参与者，年龄均在18岁及以上、新诊断为房颤（持续时间长达6周）、有至少一名研究人员确定的中风危险因素。
研究组对基线检查时接受心脏复律和未接受心脏复律的患者，以及接受直流电心脏复律和药物心脏复律的患者进行比较。采用Cox比例风险模型的重叠倾向加权来评估心脏复律对临床终点（全因死亡率、非出血性卒中或系统性栓塞、大出血）的影响，并根据基线风险和患者选择进行校正。
44201名患者被纳入比较心脏复律和非心脏复律的分析，其中6595名（14.9%）患者在基线检查时接受了心脏复律。从基线检查到一年随访，心脏复律组全因死亡的倾向评分加权危险比为0.74，从一年到两年随访，倾向评分加权危险比为0.77。在基线检查时接受过心脏复律治疗的6595名患者中，299名在登记后48天以上接受了后续心脏复律治疗。
研究组在比较心脏复律类型的分析中，对7175名患者进行了评估：2427名（33.8%）接受药物心脏复律，4748名（66.2%）接受直流心脏复律。在一年的随访期间，接受直流电和药物心脏复律的患者全因死亡发生率（每100患者-年）分别为1.36例和1.70例。
研究结果表明，在近期发作的非瓣膜性房颤患者中，有一小部分接受了心脏复律治疗。直流电复律的使用频率是药物复律的两倍，两种复律方式的终点事件似乎没有重大差异。对于整体心脏复律组，在校正混杂因素后，发现接受早期心脏复律患者的死亡率明显低于未接受早期心脏复律的患者。
附：英文原文
Title: Cardioversion in patients with newly diagnosed non-valvular atrial fibrillation: observational study using prospectively collected registry data
Author: Marita Knudsen Pope, Trygve S Hall, Valentina Schirripa, Petra Radic, Saverio Virdone, Karen S Pieper, Jean-Yves Le Heuzey, Petr Jansky, David A Fitzmaurice, Riccardo Cappato, Dan Atar, A John Camm, Ajay K Kakkar
Issue&Volume: 2021/10/27
Abstract:
Objective To investigate the clinical outcomes of patients who underwent cardioversion compared with those who did not have cardioverson in a large dataset of patients with recent onset non-valvular atrial fibrillation.
Design Observational study using prospectively collected registry data (Global Anticoagulant Registry in the FIELD-AF—GARFIELD-AF).
Setting 1317 participating sites in 35 countries.
Participants 52057 patients aged 18 years and older with newly diagnosed atrial fibrillation (up to six weeks’ duration) and at least one investigator determined stroke risk factor.
Main outcome measures Comparisons were made between patients who received cardioversion and those who had no cardioversion at baseline, and between patients who received direct current cardioversion and those who had pharmacological cardioversion. Overlap propensity weighting with Cox proportional hazards models was used to evaluate the effect of cardioversion on clinical endpoints (all cause mortality, non-haemorrhagic stroke or systemic embolism, and major bleeding), adjusting for baseline risk and patient selection.
Results 44201 patients were included in the analysis comparing cardioversion and no cardioversion, and of these, 6595 (14.9%) underwent cardioversion at baseline. The propensity score weighted hazard ratio for all cause mortality in the cardioversion group was 0.74 (95% confidence interval 0.63 to 0.86) from baseline to one year follow-up and 0.77 (0.64 to 0.93) from one year to two year follow-up. Of the 6595 patients who had cardioversion at baseline, 299 had a follow-up cardioversion more than 48 days after enrolment. 7175 patients were assessed in the analysis comparing type of cardioversion: 2427 (33.8%) received pharmacological cardioversion and 4748 (66.2%) had direct current cardioversion. During one year follow-up, event rates (per 100 patient years) for all cause mortality in patients who received direct current and pharmacological cardioversion were 1.36 (1.13 to 1.64) and 1.70 (1.35 to 2.14), respectively.
Conclusion In this large dataset of patients with recent onset non-valvular atrial fibrillation, a small proportion were treated with cardioversion. Direct current cardioversion was performed twice as often as pharmacological cardioversion, and there appeared to be no major difference in outcome events for these two cardioversion modalities. For the overall cardioversion group, after adjustments for confounders, a significantly lower risk of mortality was found in patients who received early cardioversion compared with those who did not receive early cardioversion.
DOI: 10.1136/bmj-2021-066450
Source: https://www.bmj.com/content/375/bmj-2021-066450
BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
官方网址：http://www.bmj.com/
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本期文章：《英国医学杂志》：Online/在线发表
