Practical Issue of Pharmacological Management in Paroxysmal Atrial Fibrillation Patients Treated with Anticoagulant Therapy
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概要
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<B>Methods:</B> During rhythm control therapy, 505 patients with paroxysmal atrial fibrillation (AF) (341 males, mean age 66±12 years, follow-up period 51±34 months) were divided into two groups: AF group treated with anticoagulant therapy (AT) (A-Group, N=173) and those treated without AT (B-Group, N=332). Cardiovascular events included the composite of hospitalization for thromboembolism, heart failure and cardiovascular death. <B>Results:</B> (1) The incidence of hypertension, dyslipidemia and underlying heart disease (UHD) were significantly higher in A-group than those in B-group (all, P<0.05). Left ventricular ejection fraction (LVEF) was significantly lower in A-group (65±11%) than that in B-group (69±10%) (P<0.05). (2) Survival rates free from thromboembolism at 12, 36, 60 and 120 months were 99%, 99%, 98% and 97% in A-group, and 98%, 96%, 92% and 89% in B-group, respectively (P<0.001, A-group versus B-group). (3) However, annual rate of hospitalization for heart failure was significantly greater in A-group (2.4%/year) than that in B-group (1.3%/year) (P<0.05). As a result, survival rates free from cardiovascular events at 12, 36, 60 and 120 months were 99%, 93%, 89% and 85% in A-group, and 98%, 96%, 92% and 83% in B-group (P=NS), respectively. In a multivariate logistic regression analysis, CHA2DS2-VASc score (Odds ratio [OR] 3.95, P<0.001), LVEF (OR 0.91, P=0.003), AF recurrence (OR 6.36, P=0.017) and UHD (OR 3.41, P=0.048) were associated with cardiovascular events. <B>Conclusion:</B> These results suggested therapeutic approach for the prevention of heart failure and AF recurrence might be required to improve cardiovascular prognosis in paroxysmal AF patients treated with AT.
著者
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Tachibana Hideaki
Division Of Cardiology Department Of Internal Medicine And Memorial Heart Center Iwate Medical Unive
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Komatsu Takashi
Division Of Cardiology Department Of Internal Medicine And Memorial Heart Center Iwate Medical Unive
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Nakamura Motoyuki
Division Of Cardiology Department Of Internal Medicine And Memorial Heart Center Iwate Medical Unive
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Satoh Yoshihiro
Division Of Cardiology Department Of Medicine Nihon University School Of Medicine
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Tachibana Hideaki
Division of Cardiology, Department of Internal Medicine and Memorial Heart Center, Iwate Medical University School of Medicine
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Ozawa Mahito
Division of Cardiology, Department of Internal Medicine and Memorial Heart Center, Iwate Medical University School of Medicine
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Ozawa Mahito
Division of Cardio-angiology, Nephrology and Endocrinology, Department of Internal Medicine, Iwate Medical University
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Satoh Yoshihiro
Division of Cardiology, Department of Internal Medicine and Memorial Heart Center, Iwate Medical University School of Medicine
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Kunugita Fusanori
Division of Cardio-angiology, Nephrology and Endocrinology, Department of Internal Medicine, Iwate Medical University
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Nakamura Motoyuki
Division of Cardioangiology, Department of Internal Medicine, Iwate Medical University
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Tachibana Hideaki
Division of Cardio-angiology, Nephrology and Endocrinology, Department of Internal Medicine, Iwate Medical University
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KOMATSU Takashi
Division of Cardio-angiology, Nephrology and Endocrinology, Department of Internal Medicine, Iwate Medical University
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NAKAMURA Motoyuki
Division of Cardio-angiology, Nephrology and Endocrinology, Department of Internal Medicine, Iwate Medical University
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