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Alcohol Abstinence in Drinkers with Atrial Fibrillation
背景与目的
过量饮酒与偶发性房颤和不良的心房重构有关；然而，戒酒对房颤二级预防的作用尚不清楚。
方 法
我们在澳大利亚的六家医院进行了一项多中心、前瞻性、开放性、随机、对照试验。收集每周饮用10杯或10杯以上标准饮品（1杯标准饮品中含约12g纯酒精）的成年人，且在窦性心律基础上伴有阵发性或持续性房颤，将他们按1:1的比例进行随机分配，一组戒酒，一组继续正常饮酒。两个主要结局是随访6个月期间无房颤复发（排除2周“戒断期”）和房颤总负荷（房颤发生的时间比例）。
结 果
140名接受随机分组的患者中（85%为男性；平均年龄[±SD] 62±9岁），70名患者被分到戒酒组，70名被分到对照组。戒酒组患者每周饮酒量由16.8±7.7降至2.1±3.7（下降87.5%），对照组每周饮酒量由16.4±6.9降至13.2±6.5（下降19.5%）。经过2周戒断期，戒酒组70例中有37例（53%）房颤复发，对照组70例中有51例（73%）房颤复发。与对照组相比，戒酒组房颤复发前的间隔时间更长(危险比为0.55;95%CI 0.36 ~ 0.84;P = 0.005)。为期6个月的随访中，戒酒组的房颤负荷明显低于对照组（房颤发生时间的中位数百分比为0.5%[四分位数范围:0.0~3.0] vs. 1.2%[四分位数范围，0.0~10.3]；P=0.01）。
结 论
戒酒可减少房颤酗酒者的心律失常复发。
原始文献来源及摘要
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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贵州医科大学高鸿教授课题组
翻译：冯玉蓉 编辑：冯玉蓉 审校：曹莹
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