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Alcohol Abstinence in Drinkers with Atrial Fibrillation
背景與目的
過(guò)量飲酒與偶發(fā)性房顫和不良的心房重構(gòu)有關(guān)；然而，戒酒對(duì)房顫二級(jí)預(yù)防的作用尚不清楚。
方 法
我們?cè)诎拇罄麃喌牧裔t(yī)院進(jìn)行了一項(xiàng)多中心、前瞻性、開(kāi)放性、隨機(jī)、對(duì)照試驗(yàn)。收集每周飲用10杯或10杯以上標(biāo)準(zhǔn)飲品（1杯標(biāo)準(zhǔn)飲品中含約12g純酒精）的成年人，且在竇性心律基礎(chǔ)上伴有陣發(fā)性或持續(xù)性房顫，將他們按1:1的比例進(jìn)行隨機(jī)分配，一組戒酒，一組繼續(xù)正常飲酒。兩個(gè)主要結(jié)局是隨訪6個(gè)月期間無(wú)房顫復(fù)發(fā)（排除2周“戒斷期”）和房顫總負(fù)荷（房顫發(fā)生的時(shí)間比例）。
結(jié) 果
140名接受隨機(jī)分組的患者中（85%為男性；平均年齡[±SD] 62±9歲），70名患者被分到戒酒組，70名被分到對(duì)照組。戒酒組患者每周飲酒量由16.8±7.7降至2.1±3.7（下降87.5%），對(duì)照組每周飲酒量由16.4±6.9降至13.2±6.5（下降19.5%）。經(jīng)過(guò)2周戒斷期，戒酒組70例中有37例（53%）房顫復(fù)發(fā)，對(duì)照組70例中有51例（73%）房顫復(fù)發(fā)。與對(duì)照組相比，戒酒組房顫復(fù)發(fā)前的間隔時(shí)間更長(zhǎng)(危險(xiǎn)比為0.55;95%CI 0.36 ~ 0.84;P = 0.005)。為期6個(gè)月的隨訪中，戒酒組的房顫負(fù)荷明顯低于對(duì)照組（房顫發(fā)生時(shí)間的中位數(shù)百分比為0.5%[四分位數(shù)范圍:0.0~3.0] vs. 1.2%[四分位數(shù)范圍，0.0~10.3]；P=0.01）。
結(jié) 論
戒酒可減少房顫酗酒者的心律失常復(fù)發(fā)。
原始文獻(xiàn)來(lái)源及摘要
Voskoboinik A, Kalman JM, De Silva A, et al. Alcohol Abstinence in Drinkers with Atrial Fibrillation.[J].N. Engl. J. Med. 2020,382(1):20-28.
Abstract
BACKGROUND
Excessive alcohol consumption is associated with incident atrial fibrillation and adverse atrial remodeling; however, the effect of abstinence from alcohol on secondary prevention of atrial fibrillation is unclear.
METHODS
We conducted a multicenter, prospective, open-label, randomized, controlled trial at six hospitals in Australia. Adults who consumed 10 or more standard drinks (with 1 standard drink containing approximately 12 g of pure alcohol) per week and who had paroxysmal or persistent atrial fibrillation in sinus rhythm at baseline were randomly assigned in a 1:1 ratio to either abstain from alcohol or continue their usual alcohol consumption. The two primary end points were freedom from recurrence of atrial fibrillation (after a 2-week “blanking period”) and total atrial fibrillation burden (proportion of time in atrial fibrillation) during 6 months of follow-up.
RESULTS
Of 140 patients who underwent randomization (85% men; mean [±SD] age, 62±9 years), 70 were assigned to the abstinence group and 70 to the control group. Patients in the abstinence group reduced their alcohol intake from 16.8±7.7 to 2.1±3.7 standard drinks per week (a reduction of 87.5%), and patients in the control group reduced their alcohol intake from 16.4±6.9 to 13.2±6.5 drinks per week (a reduction of 19.5%). After a 2-week blanking period, atrial fibrillation recurred in 37 of 70 patients (53%) in the abstinence group and in 51 of 70 patients (73%) in the control group. The abstinence group had a longer period before recurrence of atrial fibrillation than the control group (hazard ratio, 0.55; 95% confidence interval, 0.36 to 0.84; P=0.005). The atrial fibrillation burden over 6 months of follow-up was significantly lower in the abstinence group than in the control group (median percentage of time in atrial fibrillation, 0.5% [interquartile range, 0.0 to 3.0] vs. 1.2% [interquartile range, 0.0 to 10.3]; P=0.01).
CONCLUSIONS
Abstinence from alcohol reduced arrhythmia recurrences in regular drinkers with atrial fibrillation.
(Funded by the Government of Victoria Operational Infrastructure Support Program and others; Australian New Zealand Clinical Trials Registry number, ACTRN12616000256471.)
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貴州醫(yī)科大學(xué)高鴻教授課題組
翻譯：馮玉蓉 編輯：馮玉蓉 審校：曹瑩
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