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冷冻消融术和药物治疗作为心房颤动初始治疗的比较
Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation


Jason G. Andrade ... 心脑血管疾病 • 2021.01.28
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• 消融术对女性房颤患者同样有良好效果 • 冷冻消融和射频消融治疗心房颤动:疗效相似

摘要


背景

指南建议对于心房颤动患者,考虑采用导管消融术之前应试用一种或多种抗心律失常药。然而,消融术一线治疗在维持窦性心律方面可能更加有效。

 

方法

我们将303例未经治疗的有症状阵发性心房颤动患者随机分组,两组分别在初始心律控制中接受通过cryothermy球囊实施的导管消融术和抗心律失常药治疗。所有患者均接受了植入式心脏监测设备,用于检测房性快速性心律失常。随访期为12个月。主要终点是在导管消融术或抗心律失常药开始用药后91~365日首次记录的房性快速性心律失常(心房颤动、心房扑动或房性心动过速)复发。次要终点包括不存在有症状的心律失常、心房颤动负担和生活质量。

 

结果

1年时,消融术组154例患者中的66例(42.9%)和抗心律失常药组149例患者中的101例(67.8%)出现了房性快速性心律失常复发(风险比,0.48;95%置信区间[CI],0.35~0.66;P<0.001)。消融术组11%的患者和抗心律失常药组26.2%的患者出现了有症状的房性快速性心律失常(风险比,0.39;95% CI,0.22~0.68)。在消融术组和抗心律失常药组中,患者心房颤动的中位时间百分比分别为0(四分位距,0~0.08)和0.13%(四分位距,0~1.60)。消融术组5例患者(3.2%)和抗心律失常药组6例患者(4.0%)发生了严重不良事件。

 

结论

在接受初始治疗的有症状阵发性心房颤动患者中,连续心律监测表明,患者接受冷冻球囊导管消融术后的心房颤动复发率显著低于接受抗心律失常药治疗后(由加拿大心律失常网络[Cardiac Arrhythmia Network of Canada]等资助,EARLY-AF在ClinicalTrials.gov注册号为NCT02825979)。





作者信息

Jason G. Andrade, M.D., George A. Wells, Ph.D., Marc W. Deyell, M.D., Matthew Bennett, M.D., Vidal Essebag, M.D., Ph.D., Jean Champagne, M.D., Jean-Francois Roux, M.D., Derek Yung, M.D., Allan Skanes, M.D., Yaariv Khaykin, M.D., Carlos Morillo, M.D., Umjeet Jolly, M.D., Paul Novak, M.D., Evan Lockwood, M.D., Guy Amit, M.D., Paul Angaran, M.D., John Sapp, M.D., Stephan Wardell, M.D., Sandra Lauck, Ph.D., Laurent Macle, M.D., and Atul Verma, M.D. for the EARLY-AF Investigators*
From Vancouver General Hospital (J.G.A., M.B.), the University of British Columbia (J.G.A., M.W.D., M.B., S.L.), and the Centre for Cardiovascular Innovation (J.G.A., M.W.D.), Vancouver, Montreal Heart Institute, Université de Montréal (J.G.A., L.M.) and McGill University Health Centre (V.E.), Montreal, the University of Ottawa Heart Institute, Ottawa (G.A.W.), Université Laval, Quebec, QC (J.C.), Université de Sherbrooke, Sherbrooke, QC (J.-F.R.), Rouge Valley Centenary Hospital, Scarborough, ON (D.Y.), Western University, London, ON (A.S.), Southlake Regional Health Centre, University of Toronto, Newmarket, ON (Y.K., A.V.), Libin Cardiovascular Institute, University of Calgary, Calgary, AB (C.M.), St. Mary’s General Hospital, Kitchener, ON (U.J.), Royal Jubilee Hospital, Victoria, BC (P.N.), Royal Alexandra Hospital, Edmonton, AB (E.L.), McMaster University, Hamilton, ON (G.A.), St. Michael’s Hospital, University of Toronto, Toronto (P.A.), Dalhousie University, Halifax, NS (J.S.), and the University of Saskatchewan, Saskatoon, SK (S.W.) — all in Canada. Address reprint requests to Dr. Andrade at Vancouver General Hospital, Rm. 9159, 9th Fl. Cardiology, 2775 Laurel St., Vancouver, BC V5Z 1M9, Canada, or at jason.andrade@vch.ca. *A list of the EARLY-AF committee members and investigators is provided in the Supplementary Appendix, available at NEJM.org.

 

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