Optimal Treatment Strategy for Patients With Paroxysmal Atrial Fibrillation -J-RHYTHM Study-

被引：142

作者：

Ogawa, Satoshi ^{[1
]}

Yamashita, Takeshi ^{[2
]}

Yamazaki, Tsutomu ^{[3
]}

Aizawa, Yoshifusa ^{[4
]}

Atarashi, Hirotsugu ^{[5
]}

Inoue, Hiroshi ^{[6
]}

Ohe, Tohru ^{[7
]}

Ohtsu, Hiroshi ^{[3
]}

Okumura, Ken ^{[8
]}

Katoh, Takao ^{[9
]}

Kamakura, Shiro ^{[10
]}

Kumagai, Koichiro ^{[11
]}

Kurachi, Yoshihisa ^{[12
]}

Kodama, Itsuo ^{[13
]}

Koretsune, Yukihiro ^{[14
]}

Saikawa, Tetsunori ^{[15
]}

Sakurai, Masayuki ^{[16
]}

Sugi, Kaoru ^{[17
]}

Tabuchi, Toshifumi ^{[18
]}

Nakaya, Haruaki ^{[19
]}

Nakayama, Toshio ^{[20
]}

Hirai, Makoto

Fukatani, Masahiko ^{[21
]}

Mitamura, Hideo ^{[22
]}

机构：

[1] Keio Univ, Dept Cardiol, Tokyo, Japan

[2] Cardiovasc Inst, Minato Ku, Tokyo 1060032, Japan

[3] Univ Tokyo, Tokyo, Japan

[4] Niigata Univ, Grad Sch Med & Dent Sci, Div Cardiol, Niigata, Japan

[5] Tama Nagayama Hosp, Nippon Med Sch, Tama, Japan

[6] Toyama Univ, Dept Internal Med 2, Toyama 930, Japan

[7] Okayama Univ, Okayama, Japan

[8] Hirosaki Univ, Hirosaki, Aomori, Japan

[9] Nippon Med Sch, Tokyo 113, Japan

[10] Natl Cardiovasc Ctr, Suita, Osaka 565, Japan

[11] Fukuoka Univ, Fukuoka 81401, Japan

[12] Osaka Univ, Dept Pharmacol 2, Osaka, Japan

[13] Nagoya Univ, Environm Med Res Inst, Nagoya, Aichi 464, Japan

[14] Osaka Natl Hosp, Inst Clin Res, Osaka, Japan

[15] Oita Univ, Oita 87011, Japan

[16] Hokko Mem Hosp, Dept Cardiol, Sapporo, Hokkaido, Japan

[17] Toho Univ, Ohashi Med Ctr, Div Cardiovasc Med, Tokyo, Japan

[18] Tabuchi Naika, Kumamoto, Japan

[19] Chiba Univ, Dept Pharmacol, Chiba, Japan

[20] Nakayama Clin, Utsunomiya, Tochigi, Japan

[21] Chikamori Hosp, Kochi, Japan

[22] Saiseikai Cent Hosp, Tokyo, Japan

来源：

CIRCULATION JOURNAL | 2009年 / 73卷 / 02期

关键词：

Antiarrhythmic agents; Atrial fibrillation (AF); Mortality; Morbidity; FOLLOW-UP; NATURAL-HISTORY; MORTALITY; POPULATION; MANAGEMENT; RISK; CLASSIFICATION; COST;

D O I：

10.1253/circj.CJ-08-0608

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Although previous clinical trials demonstrated the non-inferiority of a rate control to rhythm control strategy for management of atrial fibrillation (AF), the optimal treatment strategy for paroxysmal AF (PAF) remains unclear. Methods and Results A randomized, multicenter comparison of rate control vs rhythm control in Japanese patients with PAF (the Japanese Rhythm Management Trial for Atrial Fibrillation (J-RHYTHM) study) was conducted. The primary endpoint was a composite of total mortality, symptomatic cerebral infarction, systemic embolism, major bleeding, hospitalization for heart failure, or physical/psychological disability requiring alteration of treatment strategy. In the study, 823 patients with PAF were followed for a mean period of 578 days. The primary endpoint occurred in 64 patients (15.3%) assigned to rhythm control and in 89 patients (22.0%) to rate control (P=0.0128). No significant differences between the treatment strategies were observed in the incidences of death, stroke, bleeding and heart failure. Meanwhile, significantly fewer patients requested changes of assigned treatment strategy in the rhythm control vs the rate control group, which was accompanied by improvement in AF-specific quality of life scores. Conclusion The J-RHYTHM study showed that rhythm control was associated with fewer primary endpoints than rate control. However, mortality and cardiovascular morbidity were not affected by the treatment strategy (umin-CTR No.C000000106). (Circ J 2009;73:242-248)

引用

页码：242 / 248

页数：7

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