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Early Rhythm Control in Patients With Incident Atrial Fibrillation Who Had a Prior Stroke

医学 心房颤动 冲程(发动机) 节奏 内科学 入射(几何) 心脏复律 心脏病学 儿科 机械工程 物理 光学 工程类
作者
So‐Ryoung Lee,Eue Keun Choi,Seung-Woo Lee,Kyungdo Han,Seil Oh,Gregory Y.H. Lip
出处
期刊:JACC: Clinical Electrophysiology [Elsevier BV]
卷期号:9 (7): 1121-1133 被引量:1
标识
DOI:10.1016/j.jacep.2022.11.021
摘要

There are limited data regarding the benefit of early rhythm control therapy for secondary prevention for stroke in patients with atrial fibrillation (AF). This study aimed to compare the risk of recurrent stroke between early rhythm control therapy and usual care in patients with new-onset AF and a history of prior stroke. Using the Korean nationwide claims database, the investigators identified patients who were newly diagnosed with AF and had a history of prior stroke. Patients who received rhythm control therapy, including antiarrhythmic drug, direct current cardioversion, or AF catheter ablation, within 1 year after incident AF were defined as the early rhythm control group, and the others were the usual care group. The propensity score weighting method was used to balance baseline characteristics between the 2 groups. Incident stroke was evaluated as a primary outcome. A total of 53,509 patients were included (12,455 in the early rhythm control group and 41,054 in the usual care group). All patients were prescribed oral anticoagulants. During a median 2.6 years of follow-up, 4,382 patients had an incident stroke (incidence rate: 2.6 per 100 person-years). Early rhythm control was associated with a lower risk of recurrent stroke compared to the risk associated with usual care (weighted HR: 0.720; 95% CI: 0.666-0.779; P < 0.001). Early rhythm control within 1 year after AF diagnosis might be beneficial to prevent recurrent stroke in patients with incident AF and a history of stroke. Integrated care, including optimal rhythm control with appropriate anticoagulation, should be considered in this population.
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