提示: 手机请竖屏浏览!

Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation

Nikki A.H.A. Pluymaekers ... 心脑血管疾病 • 2019.04.18
• 再次评价应用地高辛治疗永久性房颤 • 将急性“不稳定”房颤复律可否改善血流动力学 • 有关心房颤动治疗的重要新研究 • 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












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)。


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.



1.January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2014;64(21):e1-e76.

2. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016;37:2893-2962.

3. Crijns HJ, Bash LD, Chazelle F, et al. RHYTHM-AF: design of an international registry on cardioversion of atrial fibrillation and characteristics of participating centers. BMC Cardiovasc Disord 2012;12:85-85.

4. Danias PG, Caulfield TA, Weigner MJ, Silverman DI, Manning WJ. Likelihood of spontaneous conversion of atrial fibrillation to sinus rhythm. J Am Coll Cardiol 1998;31:588-592.

5. Lindberg S, Hansen S, Nielsen T. Spontaneous conversion of first onset atrial fibrillation. Intern Med J 2012;42:1195-1199.

6. Geleris P, Stavrati A, Afthonidis D, Kirpizidis H, Boudoulas H. Spontaneous conversion to sinus rhythm of recent (within 24 hours) atrial fibrillation. J Cardiol 2001;37:103-107.

7. Cotter G, Blatt A, Kaluski E, et al. Conversion of recent onset paroxysmal atrial fibrillation to normal sinus rhythm: the effect of no treatment and high-dose amiodarone: a randomized, placebo-controlled study. Eur Heart J 1999;20:1833-1842.

8. Decker WW, Smars PA, Vaidyanathan L, et al. A prospective, randomized trial of an emergency department observation unit for acute onset atrial fibrillation. Ann Emerg Med 2008;52:322-328.

9. Doyle B, Reeves M. “Wait and see” approach to the emergency department cardioversion of acute atrial fibrillation. Emerg Med Int 2011;2011:545023-545023.

10. Dudink E, Essers B, Holvoet W, et al. Acute cardioversion vs a wait-and-see approach for recent-onset symptomatic atrial fibrillation in the emergency department: rationale and design of the randomized ACWAS trial. Am Heart J 2017;183:49-53.

11. Van Gelder IC, Groenveld HF, Crijns HJGM, et al. Lenient versus strict rate control in patients with atrial fibrillation. N Engl J Med 2010;362:1363-1373.

12. European Heart Rhythm Association. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010;31:2369-2429.

13. Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on atrial fibrillation. Chest 2010;137:263-272.

14. Tieleman RG, Plantinga Y, Rinkes D, et al. Validation and clinical use of a novel diagnostic device for screening of atrial fibrillation. Europace 2014;16:1291-1295.

15. Spertus J, Dorian P, Bubien R, et al. Development and validation of the Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) Questionnaire in patients with atrial fibrillation. Circ Arrhythm Electrophysiol 2011;4:15-25.

16. Farrington CP, Manning G. Test statistics and sample size formulae for comparative binomial trials with null hypothesis of non-zero risk difference or non-unity relative risk. Stat Med 1990;9:1447-1454.

17. Little RJ, D’Agostino R, Cohen ML, et al. The prevention and treatment of missing data in clinical trials. N Engl J Med 2012;367:1355-1360.

18. Mauri L, D’Agostino RB Sr. Challenges in the design and interpretation of noninferiority trials. N Engl J Med 2017;377:1357-1367.

19. Charitos EI, Pürerfellner H, Glotzer TV, Ziegler PD. Clinical classifications of atrial fibrillation poorly reflect its temporal persistence: insights from 1,195 patients continuously monitored with implantable devices. J Am Coll Cardiol 2014;63:2840-2848.

20. Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2018;20(1):e1-e160.

21. Verma A, Jiang C, Betts TR, et al. Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med 2015;372:1812-1822.

22. Nuotio I, Hartikainen JE, Grönberg T, Biancari F, Airaksinen KE. Time to cardioversion for acute atrial fibrillation and thromboembolic complications. JAMA 2014;312:647-649.

23. Coll-Vinent B, Martín A, Sánchez J, et al. Benefits of emergency departments’ contribution to stroke prophylaxis in atrial fibrillation: the EMERG-AF Study (Emergency Department Stroke Prophylaxis and Guidelines Implementation in Atrial Fibrillation). Stroke 2017;48:1344-1352.

24. Nieuwlaat R, Dinh T, Olsson SB, et al. Should we abandon the common practice of withholding oral anticoagulation in paroxysmal atrial fibrillation? Eur Heart J 2008;29:915-922.

25. Airaksinen KE, Grönberg T, Nuotio I, et al. Thromboembolic complications after cardioversion of acute atrial fibrillation: the FinCV (Finnish CardioVersion) study. J Am Coll Cardiol 2013;62:1187-1192.

26. Daoud EG, Glotzer TV, Wyse DG, et al. Temporal relationship of atrial tachyarrhythmias, cerebrovascular events, and systemic emboli based on stored device data: a subgroup analysis of TRENDS. Heart Rhythm 2011;8:1416-1423.

27. Brambatti M, Connolly SJ, Gold MR, et al. Temporal relationship between subclinical atrial fibrillation and embolic events. Circulation 2014;129:2094-2099.

28. Pisters R, Nieuwlaat R, Prins MH, et al. Clinical correlates of immediate success and outcome at 1-year follow-up of real-world cardioversion of atrial fibrillation: the Euro Heart Survey. Europace 2012;14:666-674.

29. Lip GYH, Gitt AK, Le Heuzey J-Y, et al. Overtreatment and undertreatment with anticoagulation in relation to cardioversion of atrial fibrillation (the RHYTHM-AF study). Am J Cardiol 2014;113:480-484.

30. Klein AL, Grimm RA, Murray RD, et al. Use of transesophageal echocardiography to guide cardioversion in patients with atrial fibrillation. N Engl J Med 2001;344:1411-1420.

服务条款 | 隐私政策 | 联系我们