Objective To investigate whether the results of a rhythm control strategy differ according to the duration between diagnosis of atrial fibrillation and treatment initiation. Design Longitudinal observational cohort study. Setting Population based cohort from the Korean National Health Insurance Service database. Participants 22 635 adults with atrial fibrillation and cardiovascular conditions, newly treated with rhythm control (antiarrhythmic drugs or ablation) or rate control strategies between 28 July 2011 and 31 December 2015. Main outcome measure A composite outcome of death from cardiovascular causes, ischaemic stroke, admission to hospital for heart failure, or acute myocardial infarction. Results Of the study population, 12 200 (53.9%) were male, the median age was 70, and the median follow-up duration was 2.1 years. Among patients with early treatment for atrial fibrillation (initiated within one year since diagnosis), compared with rate control, rhythm control was associated with a lower risk of the primary composite outcome (weighted incidence rate per 100 person years 7.42 in rhythm control v 9.25 in rate control; hazard ratio 0.81, 95% confidence interval 0.71 to 0.93; P=0.002). No difference in the risk of the primary composite outcome was found between rhythm and rate control (weighted incidence rate per 100 person years 8.67 in rhythm control v 8.99 in rate control; 0.97, 0.78 to 1.20; P=0.76) in patients with late treatment for atrial fibrillation (initiated after one year since diagnosis). No significant differences in safety outcomes were found between the rhythm and rate control strategies across different treatment timings. Earlier initiation of treatment was linearly associated with more favourable cardiovascular outcomes for rhythm control compared with rate control. Conclusions Early initiation of rhythm control treatment was associated with a lower risk of adverse cardiovascular outcomes than rate control treatment in patients with recently diagnosed atrial fibrillation. This association was not found in patients who had had atrial fibrillation for more than one year.

中文翻译：

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房颤患者的治疗时机和节律控制策略的影响：全国队列研究

目的根据心房颤动的诊断和治疗开始之间的持续时间，研究节律控制策略的结果是否有所不同。设计纵向观察队列研究。从韩国国民健康保险服务数据库设置基于人群的队列。研究对象2011年7月28日至2015年12月31日期间接受心律控制（抗心律失常药物或消融术）或速率控制策略新治疗的22 635名患有心房颤动和心血管疾病的成年人。因心力衰竭或急性心肌梗塞入院。结果在研究人群中，男性为12 200（53.9％），中位年龄为70岁，中位随访时间为2.1年。在心房颤动的早期治疗（自确诊后一年内开始）的患者中，与心率控制相比，心律控制与主要复合结局的风险较低（心律控制的加权每100人年发病率7.42 vs. 9.25）。控制率;危险比0.81,95％置信区间0.71至0.93; P = 0.002）。在后期治疗的患者中，心律和速率控制之间的主要复合终点风险无差异（节奏控制中每100人年的加权发生率8.67，速率控制中为8.99； 0.97，0.78至1.20； P = 0.76）用于心房颤动（自确诊一年后开始）。在不同治疗时间的节律和速率控制策略之间，安全性结果无显着差异。与速率控制相比，较早开始治疗与控制心律的心血管预后更好相关。结论在最近诊断为心房颤动的患者中，早期进行节律控制治疗与不良心血管事件发生的风险比进行率控制治疗要低。心房纤颤超过一年的患者中未发现这种关联。