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Tratamiento profiláctico continuo versus episódico con amiodarona para la prevención de la fibrilación auricular: un
Sheba Ahmed1, Michiel Rienstra, Harry J G M Crijns
1Department of Cardiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
JAMA
|October 16, 2008
Resumen
El tratamiento episódico con amiodarona para la fibrilación auricular no difería en los eventos adversos importantes, pero aumentó la recurrencia y la mortalidad. El tratamiento continuo mantuvo el ritmo sinusal con menos recurrencias y menor mortalidad.
Área de la Ciencia:
- Cardiología Cardiología.
- Los ensayos clínicos son ensayos clínicos.
- Farmacología Farmacología.
Sus antecedentes:
- La amiodarona es eficaz para la fibrilación auricular, pero está asociada con eventos adversos.
- La evaluación de estrategias alternativas de tratamiento con amiodarona es crucial para la seguridad del paciente.
- La fibrilación auricular persistente sintomática recurrente plantea riesgos significativos para la salud.
Objetivo del estudio:
- Para comparar las principales reacciones adversas entre el tratamiento episódico y continuo con amiodarona para la fibrilación auricular.
- Para evaluar la eficacia de la amiodarona episódica frente a la continua en el mantenimiento del ritmo sinusal.
- Evaluar el impacto de las estrategias de tratamiento con amiodarona en la mortalidad y las hospitalizaciones.
Principales métodos:
- Un ensayo aleatorizado en el que participaron 209 pacientes con fibrilación auricular persistente sintomática recurrente.
- Los pacientes recibieron tratamiento con amiodarona después de la cardioversión, ya sea episódico o continuo.
- El objetivo primario: compuesto de amiodarona y eventos importantes relacionados con la enfermedad cardíaca; objetivos secundarios: mortalidad y hospitalizaciones.
Principales resultados:
- No hay diferencia significativa en el criterio de valoración compuesto primario entre los grupos de amiodarona episódica y continua.
- El tratamiento episódico condujo a tasas significativamente más altas de recurrencia de fibrilación auricular (80% frente a 54%).
- El tratamiento episódico se asoció con una mayor mortalidad por todas las causas y hospitalizaciones cardiovasculares (53% vs 34%).
Conclusiones:
- La amiodarona episódica no redujo los eventos adversos importantes en comparación con el tratamiento continuo.
- La amiodarona episódica aumentó significativamente la recurrencia de la fibrilación auricular.
- El tratamiento continuo con amiodarona se asocia con mejores resultados en cuanto a mortalidad y hospitalizaciones.
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