Aggressive approach and outcome in patients presenting atrial fibrillation and hypertension

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:166

Article

Conti, Alberto^1,2  Canuti, Erica^1,2  Mariannini, Yuri^1,2  Zanobetti, Maurizio^1,2  Innocenti, Francesca^1,2  Paladini, Barbara³  Pepe, Giuseppe³  Padeletti, Luigi^2,4  Gensini, Gian Franco^2,4 

[1] Univ Florence, Dept Med & Surg Crit Care, Florence, Italy

[2] Careggi Univ Hosp, Florence, Italy

[3] Careggi Univ Hosp, Emergency Dept, Florence, Italy

[4] Univ Florence, Dept Heart & Vessel Dis, Florence, Italy

关键词: Hypertension;    Atrial fibrillation;    Emergency medicine;    Pharmacological treatment;    Electrical treatment;    Intensive approach;   

DOI  :  10.1016/j.ijcard.2011.09.074

来源: Elsevier

【 摘 要 】

Aim: Aggressive approach in patients presenting atrial fibrillation (AF) and hypertension could result in improving rhythm control and reducing admission. Methods: Out of 3475 patients presenting AF, those with hypertension (n = 1739, 52%) underwent standard (n = 591, group 1, years 2004-2005) or aggressive pharmacological and electrical approach (n = 1148, group 2, years 2006-2009). Overall, in 1071 patients AF duration was less than 48 h. Primary endpoint was rhythm conversion; secondary endpoints were modalities of rhythm conversion and reduction of admissions. Results: At univariate and multivariate analyses, AF lasting less than 48 h, absence of comorbidities and younger age were independent predictors of sinus rhythm; conversely, lack of sinus rhythm, older age, AF lasting more than 48 h and comorbidities were independent predictors of hospitalization. Overall, 55% of patients achieved sinus rhythm in group 1 versus 62% in group 2 (p = 0.018). Interestingly, in patients with AF lasting less than 48 h, 89% achieved sinus rhythm, more likely by class 1C than by class III antiarrhythmic drugs (p < 0.001). Overall reduction of admission accounts for 60%; 50% of patients need admission in group 1 versus 29% in group 2 (p < 0.001). Conclusions: Aggressive pharmacological and electrical approach in patients presenting AF and hypertension significantly improved rhythm conversion overall up to 62%. Patients with AF lasting less than 48 h eventually achieved sinus rhythm up to 89%, mostly by class IC antiarrhythmic drugs. Admissions eventually reduced up to 60%. (c) 2011 Elsevier Ireland Ltd. All rights reserved.

【 授权许可】

Free