导管切除与抗心律失常药物治疗心房动:A4研究
Pierre Jaïs1, Bruno Cauchemez, Laurent Macle
1Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33604 Bordeaux-Pessac, France. pierre.jais@chu-bordeaux.fr
Circulation
|November 26, 2008
概括
导管切除在治疗心房动 (AF),维持鼻节律和改善患者生活质量方面优于抗心律失常药物. 这项研究比较了帕洛西斯马性AF患者的切除和药物策略.
科学领域:
- 心脏病学 心脏病学
- 电子生理学 电子生理学
背景情况:
- 药物治疗是心房动 (AF) 的首要治疗方法.
- 在过去的十年中,导管切除已经成为AF的重要替代治疗方法.
- 对这两种策略的疗效进行比较研究是有限的.
研究的目的:
- 为了比较导管切除与抗心律失常药物的有效性,在患有 Paroxysmal 心房的患者中.
- 评估两种治疗策略的长期结果,包括症状负担和生活质量.
主要方法:
- 一个随机的多中心试验,涉及患有抗心律不良药物耐药的偏激性AF患者.
- 患者被随机分配到导管切除 (肺静脉隔离) 或新的抗失常药物治疗中.
- 评估的结果包括AF的复发,需要药物改变,症状得分,运动能力,生活质量和AF负担在3,6和12个月.
主要成果:
- 这项研究招募了112名患者,随机分别接受了切除 (n=53) 或抗失常药物 (n=59).
- 在1年的随访中,89%的废除组患者没有复发AF,而抗心律药物组的这一比例为23% (P<0.0001).
- 经过切除术的患者在症状得分,运动能力和生活质量方面显著改善.
结论:
- 导管切除比抗不律性药物更有效地维持阴道节律在患有偏发性AF的患者.
- 与药物治疗相比,导管切除显著改善症状,运动能力和生活质量.
- 这项研究支持导管切除作为精选AF患者的优越治疗策略.
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