Rhythm Control Better Prevents Stroke than Rate Control in Patients with Concomitant Hypertrophic Cardiomyopathy and Atrial Fibrillation: A Nationwide Population Based Cohort Study with Long-Term Follow-Up.
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引用次数: 0
Abstract
Background: Atrial fibrillation (AF) increases the risks of stroke and mortality. It remains unclear whether rhythm control reduces the risk of stroke in patients with AF concomitant with hypertrophic cardiomyopathy (HCM).
Methods: We identified AF patients with HCM who were ≥ 18 years old in the Taiwan National Health Insurance Database. Patients using antiarrhythmic medications for ≥ 30 defined daily doses (DDDs) or receiving catheter ablation for AF constituted the rhythm control group. Patients using rate control medications for ≥ 30 DDDs constituted the rate control group. A multivariable Cox regression model was used to evaluate the hazard ratio (HR) for adverse cardiovascular events.
Results: We enrolled a total of 178 patients with both AF and HCM without pre-existing cardiovascular diseases. Among them, 99 were in the rhythm control group and 79 were in the rate control group. After a follow-up period of 6.47 ± 0.98 years, the rhythm control group had a lower risk of stroke than the rate control group (adjusted HR: 0.380, p = 0.031) after adjusting for covariates including use of antithrombotic agents. After excluding patients receiving catheter ablation, the rhythm control group still had a lower risk of stroke than the rate control group (adjusted HR: 0.380, p = 0.037).
Conclusions: In patients with AF and HCM, rhythm control with mainly pharmacological treatment better prevented stroke than rate control in long-term follow-up. The beneficial effect of lowering stroke risk through rhythm control was independent of oral anticoagulant use.
背景：房颤（AF）增加卒中和死亡的风险。目前尚不清楚心律控制是否能降低房颤合并肥厚性心肌病（HCM）患者中风的风险。使用≥30限定日剂量（DDDs）的抗心律失常药物或接受房颤导管消融治疗的患者构成心律对照组。使用率控制药物≥30 DDDs的患者为率对照组。采用多变量Cox回归模型评价心血管不良事件的危险比（HR）。结果：我们共入组178例房颤和HCM患者，且无既往心血管疾病。其中，节律对照组99例，速率对照组79例。在6.47±0.98年的随访期后，在调整抗栓药物使用等协变量后，节律控制组卒中风险低于节律控制组（校正HR: 0.380, p = 0.031）。在排除导管消融患者后，节律对照组卒中发生风险仍低于速率对照组（校正HR: 0.380, p = 0.037）。结论：在长期随访中，以药物为主的心律控制对房颤合并HCM患者的卒中预防效果优于控制心率。通过心律控制降低卒中风险的有益效果独立于口服抗凝剂的使用。
期刊介绍：
Acta Cardiologica Sinica welcomes all the papers in the fields related to cardiovascular medicine including basic research, vascular biology, clinical pharmacology, clinical trial, critical care medicine, coronary artery disease, interventional cardiology, arrythmia and electrophysiology, atherosclerosis, hypertension, cardiomyopathy and heart failure, valvular and structure cardiac disease, pediatric cardiology, cardiovascular surgery, and so on. We received papers from more than 20 countries and areas of the world. Currently, 40% of the papers were submitted to Acta Cardiologica Sinica from Taiwan, 20% from China, and 20% from the other countries and areas in the world. The acceptance rate for publication was around 50% in general.
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