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Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
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閉塞性心不全およびインプラント装置を有する患者の持続性心房細動の治療のためのアビオダロン対アビオダロン:AATAC多センターランダム化試験の結果

Luigi Di Biase1, Prasant Mohanty1, Sanghamitra Mohanty1

  • 1From Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, France (P.J., M.H.); Ospedale dell'Angelo, Mestre Venice, Italy (S.T., A.R.); Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., C.T.); University of Sacred Heart, Rome, Italy (G.P., M.L.N.); Akron General Hospital, OH (R.S.); Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic (P.N.); California Pacific Medical Center, San Francisco (S.B., R.H., S.H., A.N.); University of Tor Vergata, Rome, Italy (G.F.); Division of Cardiology, Stanford University, Palo Alto, CA (A.N.); Case Western Reserve University, Cleveland, OH (A.N.); Scripps Clinic, San Diego, CA (A.N.); and Dell Medical School, Austin, TX (A.N.).

Circulation
|April 1, 2016
PubMed
まとめ

カテーテル除去 (CA) は,アミオダロン (AMIO) よりも,心不全患者の持続性心房細動 (AF) の治療に有効です. CAはAMIOと比較してAF再発,入院,死亡率を大幅に減少させる.

キーワード:
アミオダロン心房細動カテーテル除去心不全

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科学分野:

  • 心臓病科
  • 電気生理学
  • 心不全 の 治療

背景:

  • 心不全患者の持続的な心房細動 (AF) は,治療上の課題を提示する.
  • この集団における持続性AFに対するカテーテル除去 (CA) とアミオダロン (AMIO) の比較効果は不明である.

研究 の 目的:

  • 持続的なAFと心不全の患者でCAとAMIOの有効性を比較する.

主な方法:

  • オープンラベルのランダム化多センター試験では,持続性AFおよび心不全 (NYHA II- III,LVEF < 40%) を有する203人の患者がCAまたはAMIOに割り当てられました.
  • 主要エンドポイントはAF再発であり,次要エンドポイントは全因死亡率と,最低24ヶ月のフォローアップ期間における計画外入院であった.

主要な成果:

  • アミオダロン (AMIO) と比較して,カテーテルアブレーション (CA) は著しく高いAF自由率 (70%対34%,P<0. 001) をもたらしました.
  • CAは2年間で計画外入院 (31%対57%,P<0. 001) と全因死亡率 (8%対18%,P=0. 037) を著しく減少させた.
  • アミオダロン治療は,CA治療と比較して治療失敗のリスクが2.5倍増加した.

結論:

  • 心不全の患者において,アミオダロン (AMIO) よりもカテーテルアブレーション (CA) が優れている.
  • CAはAFから長期にわたって解放され 高リスクグループで入院が減り 生存率が向上します