心房細動および心不全の患者の早期リズム制御療法
Andreas Rillig1,2, Christina Magnussen1,2, Ann-Kathrin Ozga3
1Department of Cardiology, University Heart and Vascular Center (A.R., C.M., P.K.), University Medical Center Hamburg-Eppendorf, Germany.
Circulation
|July 30, 2021
まとめ
早期のリズムコントロール療法では,心不全や心房細動の患者の心血管合併症が著しく減少します. このアプローチは,診断から1年以内に始めれば有益です.
科学分野:
- 心臓病科
- 電気生理学
- 心不全 の 治療
背景:
- 心不全や心房細動を患っている多くの患者は 最適な治療にも関わらず 心血管の合併症に直面しています
- 特に心不全と左心室のエジェクション分子が保存されている患者には,追加の治療が必要である.
研究 の 目的:
- 心不全および心房細動の患者における通常の治療と比較して,定期的な早期リズム制御療法 (ERC) の効果を評価する.
- 左心室噴出分数 (LVEF) の度合いが異なる患者におけるERCの第一および二次結果への影響を評価する.
主な方法:
- 798人の心不全患者 (NYHA II- III または LVEF < 50%) を対象としたランダム化EAST- AFNET4試験のサブ分析.
- 患者は,早期のリズム制御療法 (抗不律薬,カテーテル切除) または通常の治療に割り当てられました.
- フォローアップは平均5. 1年で行われました.
主要な成果:
- 複合主治のアウトカム (心血管疾患による死亡,脳卒中,心不全/急性冠状動脈症候群入院) は,通常治療と比較してERC (5. 7症例/100患者年) の頻度が低かった (7. 9症例/100患者年;HR,0. 74;P=0. 03).
- 主要な安全性評価では,ERCと通常治療の間の有意な差は示されなかった (HR,0. 85;P=0. 33).
- 左心室のエジェクション分子は両方のグループで改善され,ERCは死亡または心不全の入院の複合的な結果も改善しました.
結論:
- 心不全や心房細動を患っている患者に,早期のリズム制御療法が臨床的に有益である.
- 心筋動の診断から1年以内にリズム制御療法を開始することは,心不全の症状を発症する患者に推奨されます.
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