Rate Versus Rhythm Control in Tachycardia-Induced Cardiomyopathy Patients with Persistent Atrial Flutter
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- Oka Satoshi
- Department of Cardiology, Fujieda Municipal General Hospital
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- Kai Takahiko
- Department of Cardiology, Fujieda Municipal General Hospital
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- Hoshino Katsuomi
- Department of Cardiology, Fujieda Municipal General Hospital
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- Watanabe Kazunori
- Department of Cardiology, Fujieda Municipal General Hospital
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- Nakamura Jun
- Department of Cardiology, Fujieda Municipal General Hospital
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- Abe Makoto
- Department of Cardiology, Fujieda Municipal General Hospital
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- Watanabe Akinori
- Department of Cardiology, Fujieda Municipal General Hospital
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抄録
<p>Tachycardia-induced cardiomyopathy (TIC) is a potentially reversible cardiomyopathy caused by tachyarrhythmia. For atrial flutter (AFL) -induced TIC, a rhythm control strategy, such as catheter ablation, has been recommended. However, the efficacy of rate control has remained unclear due to the difficulty of achieving control using arrhythmic medications.</p><p>We prospectively assessed 47 symptomatic heart failure (HF) patients with left ventricular ejection fraction (LVEF) < 50% and suspected persistent AFL-induced TIC. Patients were divided into the rhythm control strategy (n = 22; treatment with catheter ablation or electrical cardioversion) and rate control strategy (n = 25; treatment with bisoprolol) groups. The latter was further divided into the strict rate control strategy (average heart rate < 80 bpm) and lenient rate control strategy (average heart rate < 110 bpm) subgroups. The primary outcome was left ventricular (LV) function recovery, which was defined as an increase in LVEF ≥ 20% or to a value of ≥ 55% after 6 months.</p><p>In the rhythm control strategy group, more patients achieved LV function recovery after 6 months (95.2% versus 60.9%, P = 0.010). The cumulative incidence of worsening HF events was significantly higher in the rate control strategy group than in the rhythm control strategy group (hazard ratio, 4.66; 95% confidence interval, 1.01-21.57). The subgroup study revealed the advantage of the strict rate control strategy for achieving LV function recovery (83.3% versus 36.4%, P = 0.036).</p><p>The rate control strategy was significantly inferior to the rhythm control strategy for the LV function recovery in TIC patients with persistent AFL. Our findings suggest that the strict rate control strategy should be aimed if the rhythm control strategy cannot be performed.</p>
収録刊行物
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- International Heart Journal
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International Heart Journal 62 (1), 119-126, 2021-01-30
一般社団法人 インターナショナル・ハート・ジャーナル刊行会