CAJ | 학술논문

目的：比较心房颤动(房颤)导管消融治疗与药物治疗的治疗效果。方法连续入选644例房颤患者,获取基线特征,应用倾向评分方法进行匹配分组,获得两组不同治疗策略的入选人群(257例),进行为期约18个月的随访,通过 Cox 比例风险模型比较导管消融和药物治疗对房颤患者一级终点房颤复发事件以及二级终点因心力衰竭住院率、血栓栓塞事件、累积生存率及生活质量改善的影响。结果(1)无房颤复发终点：导管消融术组优于抗心律失常药物治疗组( HR：3.12,95% CI：1.93~5.03,P <0.01)。(2)因心力衰竭住院率：导管消融术组与抗心律失常药物治疗组差异无统计学意义(HR：1.14,95% CI：0.67~1.94,P =0.34)。(3)血栓栓塞事件发生率：在导管消融术组和抗心律失常药物治疗组间差异无统计学意义(HR：0.98,95% CI：0.44~2.20,P =0.38)。(4)累积生存率：两组间差异无统计学意义(HR：1.05,95% CI：0.33~3.32,P =0.73)。(5)生活质量评分：抗心律失常药物组生活质量无明显改善,而导管消融术组仅对精神方面评分有显著改善(随访3个月和12个月均为 P =0.04)。结论导管消融治疗与药物治疗相比,房颤复发率更低,并可以改善精神方面的生活质量,但未能降低因心力衰竭住院率和血栓栓塞事件发生的风险,两种治疗手段的累积生存率差异无统计学意义。
목적：비교심방전동(방전)도관소융치료여약물치료적치료효과。방법련속입선644례방전환자,획취기선특정,응용경향평분방법진행필배분조,획득량조불동치료책략적입선인군(257례),진행위기약18개월적수방,통과 Cox 비례풍험모형비교도관소융화약물치료대방전환자일급종점방전복발사건이급이급종점인심력쇠갈주원솔、혈전전새사건、루적생존솔급생활질량개선적영향。결과(1)무방전복발종점：도관소융술조우우항심률실상약물치료조( HR：3.12,95% CI：1.93~5.03,P <0.01)。(2)인심력쇠갈주원솔：도관소융술조여항심률실상약물치료조차이무통계학의의(HR：1.14,95% CI：0.67~1.94,P =0.34)。(3)혈전전새사건발생솔：재도관소융술조화항심률실상약물치료조간차이무통계학의의(HR：0.98,95% CI：0.44~2.20,P =0.38)。(4)루적생존솔：량조간차이무통계학의의(HR：1.05,95% CI：0.33~3.32,P =0.73)。(5)생활질량평분：항심률실상약물조생활질량무명현개선,이도관소융술조부대정신방면평분유현저개선(수방3개월화12개월균위 P =0.04)。결론도관소융치료여약물치료상비,방전복발솔경저,병가이개선정신방면적생활질량,단미능강저인심력쇠갈주원솔화혈전전새사건발생적풍험,량충치료수단적루적생존솔차이무통계학의의。
Objective To compare the clinical efficacy between catheter ablation and antiarrhythmic drug therapy in patients with atrial fibrillation ( AF). Methods Six hundred and forty-four patients with atrial fibrillation were enrolled. The basic data were collected,and the patients were matched and grouped in two with different treatment strategies according to propensity score method (257 patients for each). The follow-up period was 18 months. The effectiveness of catheter ablation and antiarrhythmic drug therapy was compared via the Cox proportional hazards model. The primary endpoint was recurrence of atrial fibrillation. The secondary endpoints were hospitalization rate due to aggravating heart failure, the incidence of thromboembolism, the cumulative survival rate and the improvement of life quality. Results 1. The recurrence rate of atrial fibrillation was lower in catheter ablation group than in antiarrhythmic drug group (HR:3. 12, 95% CI:1. 93 - 5. 03,P < 0. 01) . 2. There was no significant difference between the two groups in the hospitalization rate due to heart failure (HR:1. 14,95% CI:0. 67 - 1. 94,P = 0. 34). 3. There was no significant difference between the two groups in the incidence of thromboembolism event (HR:0. 98, 95% CI:0. 44 - 2. 20,P = 0. 38) . 4. There was no significant difference between the two groups in the cumulative survival rate ( HR: 1. 05, 95% CI: 0. 33 - 3. 32, P = 0. 73 ) . 5. There was no significant improvement in quality of life in antiarrhythmic drug group, whereas there was significant improvement of mental health score in catheter ablation group (P = 0. 04 for the 3rd month, P = 0. 04 for the 12th month). Conclusions Compared with the antiarrhythmic drug group, there is lower recurrence of atrial fibrillation in the catheter ablation group, and better mental quality as well. However, there is no significant difference of hospitalization rate due to heart failure, thromboembolism event and cumulative survival rate between the two groups.