NEJM:低温消融或药物治疗用于房颤的初始治疗

2021-01-28 MedSci原创 MedSci原创

导管消融作为一线治疗或许比抗心律失常药物更好,它可防止房性快速性心律失常的复发,减少房颤的负担并改善患者的健康状况。

    导管消融作为一线治疗或许比抗心律失常药物更好,它可防止房性快速性心律失常的复发,减少房颤的负担并改善患者的健康状况。

    全球约有1%-2%的人群患心房颤动,它是心律不齐中最为常见的一种。 如果没有预防性治疗,则90%的患者会发生房颤。 指南建议使用抗心律失常药物作为维持有症状患者窦性心律的初始疗法。 但是,这些药物不仅功效有限,而且具有明显的副作用。


    在维持窦性心律和改善患者生活质量方面,导管消融优于抗心律失常药物。 导管消融作为一线治疗或许比抗心律失常药物更好,它可防止房性快速性心律失常的复发,减少房颤的负担并改善患者的健康状况。然而早期的射频消融试验尚无定论,并因复发性心律不齐,并发症和交叉发生率高而受到限制。


    研究人员因此将303例有症状,阵发性,未经治疗的房颤患者随机分配至两组,一组接受低温球囊消融术,另一组接受抗心律失常药物治疗以控制最初的心律。 所有患者均接受了植入式心脏监测设备以检测房性心律失常。 随访期为12个月。 主要终点是导管消融或开始使用抗心律失常药物后91到365天之间首次记录的任何房速性心律失常(房颤,房扑或房性心动过速)的复发。 次要终点包括无症状性心律不齐,房颤负担和生活质量。


    在1年时,接受消融的154例患者中有66例(42.9%)发生了房性快速性心律失常的复发,接受抗心律不齐药物的149例患者中有101例(67.8%)发生了房性心律失常的复发(危险比,0.48; 95%置信区间[CI],0.35至0.66; P <0.001)。有症状的房性快速性心律失常发生率在接受消融的患者中占11.0%,在接受抗心律失常药物的患者中占26.2%(危险比,0.39; 95%CI,0.22至0.68)。消融后心房纤颤的中位时间百分比为0%(四分位数范围为0至0.08),抗心律失常药物的中位时间百分比为0.13%(四分位数范围为0至1.60)。接受消融的5例患者(3.2%)和接受抗心律不齐药物的6例患者(4.0%)发生了严重的不良事件。
心房颤动是一种进行性疾病。 在其病程的早期,心房颤动是由最常见于肺静脉的一种或多种异位灶触发的。 在房颤自然病史的早期进行干预可通过中断进行性病理生理变化来限制疾病进展,并可能改善临床结局。 最近发表的试验结果表明,使用抗心律失常药物进行早期节律控制,可以降低包括中风在内的不良血管结果的风险。


    同时,研究人员也表示,该试验存在一些局限性。尽管主要终点——房性心律失常的复发——是消融试验的重要基准,但该试验无法检测心血管结局。其次,本试验只使用一种消融技术,因此获得的临床结果可能无法推广到其他消融能源的使用。另外,当前试验的随访时间仅限于1年,无法确定早期消融对房颤进展、医疗保健利用和成本效益的长期影响。此外,在开始治疗时便植入了心脏监护仪,因此无法评估基线时房颤负荷的变化。 最后,筛选日志没有被保留,因此也无法评价为获得试验参与者而筛选的患者人数。

    然而无论如何,本试验的结果表明,通过持续性心律监测,在接受症状性阵发性心房颤动的初始治疗的患者中,导管低温球囊消融术的房颤复发率显着低于抗心律失常药物治疗。

 

Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation,Jason G. 2021.1.28,N Engl J Med 2021; 384:305-315 DOI:10.1056 / NEJMoa2029980

原文链接:https://www.nejm.org/doi/full/10.1056/NEJMoa2029980?query=featured_home

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    2021-06-13 ms3000000546125468

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  4. [GetPortalCommentsPageByObjectIdResponse(id=973231, encodeId=adb89e3231b0, content=。。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201026/384b4f679da4456d9509d77954ef7e21/73f4281675204be69112bc911522d1a9.jpg, createdBy=336e5429283, createdName=ms3000000546125468, createdTime=Sun Jun 13 10:25:45 CST 2021, time=2021-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2022122, encodeId=ffed20221229f, content=<a href='/topic/show?id=0ca732196ef' target=_blank style='color:#2F92EE;'>#初始治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32196, encryptionId=0ca732196ef, topicName=初始治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f7482500171, createdName=ms4468361851264128, createdTime=Thu Apr 01 11:42:37 CST 2021, time=2021-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1421832, encodeId=28d4142183259, content=<a href='/topic/show?id=4bc865819d2' target=_blank style='color:#2F92EE;'>#消融#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65819, encryptionId=4bc865819d2, topicName=消融)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1a193676008, createdName=xiangyuzhou972, createdTime=Sat Jan 30 00:42:37 CST 2021, time=2021-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=921198, encodeId=b96e9211985b, content=总之比射频要好,低温球囊的介入治疗的使用还是可以代替电生理治疗的, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210226/f23705539a22465dad49b185641246f4/269e005bb68348558ceb01a4a8056073.jpg, createdBy=a54d5390453, createdName=T2DM终结者, createdTime=Fri Jan 29 20:51:13 CST 2021, time=2021-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1031348, encodeId=4b1c103134827, content=房颤,临床上碰到很多哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=心介, createdTime=Thu Jan 28 12:42:37 CST 2021, time=2021-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035560, encodeId=b364103556022, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Jan 28 12:42:37 CST 2021, time=2021-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=920663, encodeId=b9c0920663a3, content=<a href='/topic/show?id=e3bb50984cc' target=_blank style='color:#2F92EE;'>#心律#</a>通过持续性心律监测,在接受症状性阵发性心房颤动的初始治疗的患者中,导管低温球囊消融术的房颤复发率显着低于抗心律失常药物治疗, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50984, encryptionId=e3bb50984cc, topicName=心律)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200529/3611e9bb629c4e5b81fbd8ce784b06cc/128487eae357460bb98f67d86230c218.jpg, createdBy=ab235268530, createdName=神盾医疗局局长Jack, createdTime=Thu Jan 28 10:16:12 CST 2021, time=2021-01-28, status=1, ipAttribution=)]
    2021-01-29 T2DM终结者

    总之比射频要好,低温球囊的介入治疗的使用还是可以代替电生理治疗的

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=973231, encodeId=adb89e3231b0, content=。。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201026/384b4f679da4456d9509d77954ef7e21/73f4281675204be69112bc911522d1a9.jpg, createdBy=336e5429283, createdName=ms3000000546125468, createdTime=Sun Jun 13 10:25:45 CST 2021, time=2021-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2022122, encodeId=ffed20221229f, content=<a href='/topic/show?id=0ca732196ef' target=_blank style='color:#2F92EE;'>#初始治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32196, encryptionId=0ca732196ef, topicName=初始治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f7482500171, createdName=ms4468361851264128, createdTime=Thu Apr 01 11:42:37 CST 2021, time=2021-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1421832, encodeId=28d4142183259, content=<a href='/topic/show?id=4bc865819d2' target=_blank style='color:#2F92EE;'>#消融#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65819, encryptionId=4bc865819d2, topicName=消融)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1a193676008, createdName=xiangyuzhou972, createdTime=Sat Jan 30 00:42:37 CST 2021, time=2021-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=921198, encodeId=b96e9211985b, content=总之比射频要好,低温球囊的介入治疗的使用还是可以代替电生理治疗的, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210226/f23705539a22465dad49b185641246f4/269e005bb68348558ceb01a4a8056073.jpg, createdBy=a54d5390453, createdName=T2DM终结者, createdTime=Fri Jan 29 20:51:13 CST 2021, time=2021-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1031348, encodeId=4b1c103134827, content=房颤,临床上碰到很多哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=心介, createdTime=Thu Jan 28 12:42:37 CST 2021, time=2021-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035560, encodeId=b364103556022, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Jan 28 12:42:37 CST 2021, time=2021-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=920663, encodeId=b9c0920663a3, content=<a href='/topic/show?id=e3bb50984cc' target=_blank style='color:#2F92EE;'>#心律#</a>通过持续性心律监测,在接受症状性阵发性心房颤动的初始治疗的患者中,导管低温球囊消融术的房颤复发率显着低于抗心律失常药物治疗, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50984, encryptionId=e3bb50984cc, topicName=心律)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200529/3611e9bb629c4e5b81fbd8ce784b06cc/128487eae357460bb98f67d86230c218.jpg, createdBy=ab235268530, createdName=神盾医疗局局长Jack, createdTime=Thu Jan 28 10:16:12 CST 2021, time=2021-01-28, status=1, ipAttribution=)]
    2021-01-28 心介

    房颤,临床上碰到很多哦

    0

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    2021-01-28 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=973231, encodeId=adb89e3231b0, content=。。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201026/384b4f679da4456d9509d77954ef7e21/73f4281675204be69112bc911522d1a9.jpg, createdBy=336e5429283, createdName=ms3000000546125468, createdTime=Sun Jun 13 10:25:45 CST 2021, time=2021-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2022122, encodeId=ffed20221229f, content=<a href='/topic/show?id=0ca732196ef' target=_blank style='color:#2F92EE;'>#初始治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32196, encryptionId=0ca732196ef, topicName=初始治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f7482500171, createdName=ms4468361851264128, createdTime=Thu Apr 01 11:42:37 CST 2021, time=2021-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1421832, encodeId=28d4142183259, content=<a href='/topic/show?id=4bc865819d2' target=_blank style='color:#2F92EE;'>#消融#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65819, encryptionId=4bc865819d2, topicName=消融)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1a193676008, createdName=xiangyuzhou972, createdTime=Sat Jan 30 00:42:37 CST 2021, time=2021-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=921198, encodeId=b96e9211985b, content=总之比射频要好,低温球囊的介入治疗的使用还是可以代替电生理治疗的, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210226/f23705539a22465dad49b185641246f4/269e005bb68348558ceb01a4a8056073.jpg, createdBy=a54d5390453, createdName=T2DM终结者, createdTime=Fri Jan 29 20:51:13 CST 2021, time=2021-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1031348, encodeId=4b1c103134827, content=房颤,临床上碰到很多哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=心介, createdTime=Thu Jan 28 12:42:37 CST 2021, time=2021-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035560, encodeId=b364103556022, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Jan 28 12:42:37 CST 2021, time=2021-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=920663, encodeId=b9c0920663a3, content=<a href='/topic/show?id=e3bb50984cc' target=_blank style='color:#2F92EE;'>#心律#</a>通过持续性心律监测,在接受症状性阵发性心房颤动的初始治疗的患者中,导管低温球囊消融术的房颤复发率显着低于抗心律失常药物治疗, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50984, encryptionId=e3bb50984cc, topicName=心律)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200529/3611e9bb629c4e5b81fbd8ce784b06cc/128487eae357460bb98f67d86230c218.jpg, createdBy=ab235268530, createdName=神盾医疗局局长Jack, createdTime=Thu Jan 28 10:16:12 CST 2021, time=2021-01-28, status=1, ipAttribution=)]
    2021-01-28 神盾医疗局局长Jack

    #心律#通过持续性心律监测,在接受症状性阵发性心房颤动的初始治疗的患者中,导管低温球囊消融术的房颤复发率显着低于抗心律失常药物治疗

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