{"id":2113,"date":"2021-03-18T08:42:41","date_gmt":"2021-03-17T23:42:41","guid":{"rendered":"http:\/\/www.hcfm.jp\/journal\/?p=2113"},"modified":"2021-03-18T08:42:41","modified_gmt":"2021-03-17T23:42:41","slug":"%e5%bf%83%e6%88%bf%e7%b4%b0%e5%8b%95%e3%81%ae%e6%97%a9%e6%9c%9f%e3%83%aa%e3%82%ba%e3%83%a0%e3%82%b3%e3%83%b3%e3%83%88%e3%83%ad%e3%83%bc%e3%83%ab","status":"publish","type":"post","link":"https:\/\/www.hcfm.jp\/journal\/?p=2113","title":{"rendered":"\u5fc3\u623f\u7d30\u52d5\u306e\u65e9\u671f\u30ea\u30ba\u30e0\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb"},"content":{"rendered":"

\uff0d\u6587\u732e\u540d\uff0d
\nP. Kirchhof, A.J. Camm, A. Goette\uff0eEarly Rhythm-Control Therapy in Patients with Atrial Fibrillation\uff0eN Engl J Med. 2020 Oct 1;383(14):1305-1316.<\/p>\n

\uff0d\u8981\u7d04\uff0d
\n\u80cc\u666f\u3000\u5fc3\u623f\u7d30\u52d5\u306e\u60a3\u8005\u306f\u5fc3\u8840\u7ba1\u7cfb\u5408\u4f75\u75c7\u306e\u30ea\u30b9\u30af\u304c\u9ad8\u3044\uff0e\u904e\u53bb\u306b\u30ea\u30ba\u30e0\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u3068\u30ec\u30fc\u30c8\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u3067\u4e88\u5f8c\u306b\u5dee\u304c\u306a\u3044\u3068\u3044\u3046\u5831\u544a\u304c\u3042\u308b\u304c\uff0c\u767a\u75c7\u65e9\u671f\u306b\u30ea\u30ba\u30e0\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u3092\u884c\u3046\u3053\u3068\u3067\u5fc3\u8840\u7ba1\u30ea\u30b9\u30af\u3092\u8efd\u6e1b\u3067\u304d\u308b\u304b\u3069\u3046\u304b\u306f\u4e0d\u660e\u3067\u3042\u308b\uff0e\u30a2\u30d6\u30ec\u30fc\u30b7\u30e7\u30f3\u3082\u542b\u3081\u305f\u30ea\u30ba\u30e0\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u6226\u7565\u304c\u65e9\u671fAf\u8a3a\u7642\u306e\u30a2\u30a6\u30c8\u30ab\u30e0\u3092\u6539\u5584\u3055\u305b\u308b\u304b\u8abf\u3079\u308b\uff0e
\n\u30c7\u30b6\u30a4\u30f3 RCT\uff0e\u975e\u76f2\u691c\u5316\u8a66\u9a13\uff0e\u591a\u65bd\u8a2d\uff08\u6b27\u5dde11\u30ab\u56fd\uff0c135\u65bd\u8a2d\uff09\uff0e2011\u5e74\u301c2016\u5e74\uff0eITT\u89e3\u6790\uff0e
\n\u30c9\u30a4\u30c4\u306e\u6559\u80b2\u7814\u7a76\u7701\u306b\u3088\u308b\u8cc7\u91d1\u63d0\u4f9b\uff0e
\n\u5bfe\u8c61\u8005\u30002789\u4f8b\uff0e\u226718\u6b73\u306e\u767a\u75c7\u65e9\u671f\uff08\u521d\u56de\u8a3a\u65ad\u304b\u3089\u226612\u30ab\u6708\uff09\u306e\u5fc3\u623f\u7d30\u52d5\u60a3\u8005\u3067\uff0c\u2460TIA\/\u8133\u5352\u4e2d\u306e\u65e2\u5f80\u304c\u3042\u308b\u304b\uff0c\u2461\uff1e75\u6b73\u306e\u8005\u304b\uff0c\u2462\u4ee5\u4e0b\u306e\u6761\u4ef6*\u306e\u3046\u30612\u3064\u4ee5\u4e0a\u306b\u8a72\u5f53\u3059\u308b\u8005\u3002\u5e74\u9f62\uff1e65\u6b73\uff0c\u5973\u6027\uff0c\u5fc3\u4e0d\u5168\uff0c\u9ad8\u8840\u5727\uff0c\u7cd6\u5c3f\u75c5\uff0c\u91cd\u75c7\u51a0\u52d5\u8108\u75be\u60a3\uff0c\u6162\u6027\u814e\u81d3\u75c5\uff08GFR15\u301c59\uff09\uff0c\u5de6\u5ba4\u80a5\u5927\uff08\u62e1\u5f35\u671f\u4e2d\u9694\u58c1\u5e45> 15mm\uff09\uff0c\u672b\u68a2\u52d5\u8108\u75be\u60a3\uff0e
\n\u4ecb\u5165 \u73fe\u884c\u306e\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u304c\u63a8\u5968\u3059\u308b\u6cbb\u7642\uff08\u6297\u51dd\u56fa\u85ac\uff0c\u30ec\u30fc\u30c8\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\uff09\u304a\u3088\u3073\u5408\u4f75\u3059\u308b\u5fc3\u8840\u7ba1\u75be\u60a3\u306b\u5bfe\u3059\u308b\u6cbb\u7642\u3092\u53d7\u3051\u305f\u3046\u3048\u3067\uff0c\u65e9\u671f\u306e\u30ea\u30ba\u30e0\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\uff08\u6d1e\u8abf\u5f8b\u7dad\u6301\u7642\u6cd5\uff09\u7fa4\uff081395\u4f8b\uff09\u307e\u305f\u306f\u6a19\u6e96\u6cbb\u7642\u306e\u307f\u306e\u7fa4\uff081394\u4f8b\uff09\u3002
\n\u65e9\u671f\u306e\u30ea\u30ba\u30e0\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u7fa4\uff1a\u6297\u4e0d\u6574\u8108\u85ac\u307e\u305f\u306f\u5fc3\u623f\u7d30\u52d5\u30a2\u30d6\u30ec\u30fc\u30b7\u30e7\u30f3\u306b\u3088\u308b\u6cbb\u7642\uff0e\u9031\u306b2\u5ea6\u307e\u305f\u75c7\u72b6\u767a\u751f\u6642\u306f\uff0c\u60a3\u8005\u81ea\u3089\u9060\u9694\u30e2\u30cb\u30bf\u30ea\u30f3\u30b0\u30c7\u30d0\u30a4\u30b9ECG\u3092\u9001\u4fe1\uff0e\u533b\u7642\u6a5f\u95a2\u304c\u30ea\u30ba\u30e0\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u3092\u8abf\u6574\uff0e
\n\u6a19\u6e96\u6cbb\u7642\u7fa4\uff1a\u6297\u51dd\u56fa\u85ac\u306b\u3088\u308b\u6cbb\u7642\u3068\u30ec\u30fc\u30c8\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\uff08\u5fc3\u62cd\u6570\u8abf\u7bc0\u7642\u6cd5\uff09\u3092\u4e2d\u5fc3\u3068\u3057\u305f\u6cbb\u7642\u3002\u3053\u308c\u3089\u306e\u6cbb\u7642\u3067\u3082\u5fc3\u623f\u7d30\u52d5\u306b\u3088\u308b\u75c7\u72b6\u304c\u751f\u3058\u305f\u5834\u5408\u306f\uff0c\u30ea\u30ba\u30e0\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u3092\u5b9f\u65bd\u3002
\n\u7d50\u679c
\n\u8ffd\u8de1\u671f\u9593\u4e2d\u592e\u50245.1\u5e74\u3002
\n\u6709\u52b9\u6027\u304c\u78ba\u8a8d\u3055\u308c\u305f\u305f\u3081\uff0c\u7b2c3\u56de\u76ee\u306e\u4e2d\u9593\u89e3\u6790\u306e\u6642\u70b9\u3067\u8a66\u9a13\u306f\u4e2d\u6b62\u3002
\n\uff08\u4ee5\u4e0b\uff0cFig1\uff09
\n2\u5e74\u5f8c\u306e\u6cbb\u7642\u72b6\u6cc1\u306f\uff0c\u30ea\u30ba\u30e0\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u7fa4\u3067\u306f65.1%\u304c\u6297\u4e0d\u6574\u8108\u85ac\u7d99\u7d9a\uff0c\u6a19\u6e96\u6cbb\u7642\u7fa4\u3067\u306f14.6%\u304c\u6297\u4e0d\u6574\u8108\u85ac\u4f7f\u7528\uff0e\u30ea\u30ba\u30e0\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u7fa4\u3067\u30a2\u30d6\u30ec\u30fc\u30b7\u30e7\u30f3\u3092\u884c\u3063\u305f\u306e\u306f19.4\uff05\uff0e\uff08\u30d5\u30ec\u30ab\u30a4\u30cb\u30c9\uff08\u30bf\u30f3\u30dc\u30b3\u30fc\u30eb\u00ae\uff0c1c\uff09\uff0c\u30a2\u30df\u30aa\u30c0\u30ed\u30f3\uff0c\u30c9\u30ed\u30cd\u30c0\u30ed\u30f3\uff08\u65e5\u672c\u63a1\u7528\u306a\u3057\uff09\uff0c\u30d7\u30ed\u30d1\u30d5\u30a7\u30ce\u30f3\uff08\u30d7\u30ed\u30ce\u30f3\u00ae\uff0c1c\uff09\uff0c\u305d\u306e\u4ed6\u306e\u4e0d\u6574\u8108\u85ac\uff09<\/p>\n

\uff08\u4ee5\u4e0b\uff0cTable1\uff09
\n\u60a3\u8005\u80cc\u666f\uff1a\u5e73\u5747\u5e74\u9f6270.3\u6b73\uff0c\u5973\u602746.4%\u3002
\n\u5fc3\u623f\u7d30\u52d5\u306e\u8a3a\u65ad\u304b\u3089\u767b\u9332\u307e\u3067\u306e\u65e5\u6570\uff1a\u4e2d\u592e\u5024\u306736\u65e5\u3002
\n\u767b\u9332\u6642\u306e\u5fc3\u623f\u7d30\u52d5\u306e\u72b6\u6cc1\uff1a\u521d\u767a 37.6%\uff0c\u767a\u4f5c\u6027 35.6%\uff0c\u6301\u7d9a\u6027 26.6%\u3002
\n\u767b\u9332\u6642\u306e\u6d1e\u8abf\u5f8b\u306e\u5272\u5408\uff1a54.0%
\n\u767b\u9332\u6642\u306eCHA2DS2-VASC\u30b9\u30b3\u30a2\u306e\u5e73\u5747\u5024\uff1a3.4<\/p>\n

\uff08\u4ee5\u4e0b\uff0cTable.2\uff09
\n\u30d7\u30e9\u30a4\u30de\u30ea\u30fc\u30a8\u30f3\u30c9\u30dd\u30a4\u30f3\u30c8\uff1d\u300c\u5fc3\u75be\u60a3\u3084\u8133\u5352\u4e2d\u306b\u3088\u308b\u6b7b\u4ea1\u300d\u300c\u5fc3\u4e0d\u5168\u3084\u6025\u6027\u51a0\u75c7\u5019\u7fa4\u306e\u60aa\u5316\u306b\u3088\u308b\u5165\u9662\u300d\u306e\u8907\u5408
\n\u65e9\u671f\u30ea\u30ba\u30e0\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u7fa4249\u4f8b\uff083.9\/100\u4eba\u30fb\u5e74\uff09\u3000vs. \u6a19\u6e96\u6cbb\u7642\u7fa4316\u4f8b\uff085.0\/100\u4eba\u30fb\u5e74\uff09
\n\uff3b\u30cf\u30b6\u30fc\u30c9\u6bd4\uff08HR\uff090.79; 96%\u4fe1\u983c\u533a\u9593\uff08CI\uff090.66\uff5e0.94; P \uff1d0.005\uff3d
\n\u5185\u8a33\u306e\u3046\u3061\uff0c\u5fc3\u75be\u60a3\u3084\u8133\u5352\u4e2d\u306b\u3088\u308b\u6b7b\u4ea1\u3092\u307f\u3066\u3082\u6709\u610f\u5dee\u3042\u308a\uff0e<\/p>\n

\u30bb\u30ab\u30f3\u30c0\u30ea\u30fc\u30a8\u30f3\u30c9\u30dd\u30a4\u30f3\u30c8\uff1d1\u5e74\u3042\u305f\u308a\u306e\u5165\u9662\u65e5\u6570\uff0e
\n\u7fa4\u9593\u3067\u6709\u610f\u5dee\u306a\u3057\uff0e
\n\u5e73\u5747\u5024\uff1a\u65e9\u671f\u30ea\u30ba\u30e0\u30b3\u30f3\u30c8\u30fc\u30eb\u7fa4 5.8\u65e5\/\u5e74 vs. \u6a19\u6e96\u6cbb\u7642\u7fa45.1\u65e5\/\u5e74\uff08P \uff1d0.23\uff09<\/p>\n

\uff08\u4ee5\u4e0b\uff0cTable.3\uff09
\n\u5b89\u5168\u6027\u306e\u4e3b\u8981\u30a2\u30a6\u30c8\u30ab\u30e0\uff1d\u300c\u6b7b\u4ea1\u300d\u300c\u8133\u5352\u4e2d\u300d\u300c\u30ea\u30ba\u30e0\u5236\u5fa1\u7642\u6cd5\u306b\u95a2\u9023\u3057\u305f\u91cd\u7be4\u306a\u6709\u5bb3\u4e8b\u8c61\u300d\u306e\u8907\u5408
\n\u7fa4\u9593\u3067\u6709\u610f\u5dee\u306a\u3057\uff0e
\n\u65e9\u671f\u30ea\u30ba\u30e0\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u7fa4231\u4f8b\uff0816.6%\uff09vs. \u6a19\u6e96\u6cbb\u7642\u7fa4223\u4f8b\uff0816.0%\uff09<\/p>\n

\uff1c\u5185\u8a33\uff1e
\n\u8133\u5352\u4e2d\uff1a\u65e9\u671f\u30ea\u30ba\u30e0\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u7fa42.9% vs. \u6a19\u6e96\u6cbb\u7642\u7fa44.4%\uff08P \uff1d0.03\uff09\u3002
\n\u6b7b\u4ea1\uff1a9.9% vs. 11.8%\u3002
\n\u30ea\u30ba\u30e0\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u306b\u95a2\u9023\u3059\u308b\u91cd\u7be4\u306a\u6709\u5bb3\u30a4\u30d9\u30f3\u30c8\uff1a4.9% vs. 1.4%\uff08P \uff1c0.001\uff09\u3002\uff085\u5e74\u9593\uff09
\n\u3000\u2192\u975e\u81f4\u6b7b\u6027\u306e\u5fc3\u505c\u6b62\uff0c\u4e2d\u6bd2\uff0c\u5f90\u8108\uff0cAV\u30d6\u30ed\u30c3\u30af\uff0c\u30c8\u30eb\u30b5\u30fc\u30c9\u30dd\u30ef\u30f3\u30c4\uff0c\u30bf\u30f3\u30dd\u30ca\u30fc\u30c7\uff0c\u51fa\u8840\u306a\u3069<\/p>\n

\u5b89\u5168\u6027\u306e\u526f\u6b21\u30a2\u30a6\u30c8\u30ab\u30e0\uff1d2\u5e74\u5f8c\u306e\u75c7\u72b6\uff0c\u5de6\u5ba4\u6a5f\u80fd
\n\u4e21\u6cbb\u7642\u7fa4\u9593\u306b\u6709\u610f\u5dee\u306f\u8a8d\u3081\u3089\u308c\u306a\u304b\u3063\u305f\u3002<\/p>\n

\u30c7\u30a3\u30b9\u30ab\u30c3\u30b7\u30e7\u30f3\u3000
\n\u30fb\u904e\u53bb\u306e\u5831\u544a\u3068\u7570\u306a\u308a\uff0c\u4eca\u56de\u30ea\u30ba\u30e0\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u7fa4\u3067\u6709\u610f\u5dee\u304c\u51fa\u305f\u306e\u306f\uff0c\u2460\u30ab\u30c6\u30fc\u30c6\u30eb\u30a2\u30d6\u30ec\u30fc\u30b7\u30e7\u30f3\u6cbb\u7642\u7fa4\u304c\u5165\u3063\u3066\u3044\u308b\u3053\u3068\u3084\u2461\u767a\u75c7\u65e9\u671f\u306e\u4ecb\u5165\u3092\u307f\u3066\u3044\u308b\u3053\u3068\u306a\u3069\u304c\u8003\u3048\u3046\u308b\uff0e
\n\u30fb\u30ea\u30ba\u30e0\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u306b\u3088\u308b\u6709\u5bb3\u4e8b\u8c61\u306f\u6709\u610f\u306b\u767a\u751f\u3057\u305f\u304c\uff0c\u305d\u306e\u983b\u5ea6\u306f\u4f4e\u3044\uff0e
\n\u30fb\u9650\u754c\u306f\uff0c\u975e\u76f2\u691c\u5316\u8a66\u9a13\u3067\u3042\u308b\u3053\u3068\uff0c\u30d5\u30a9\u30ed\u30fc\u30a2\u30c3\u30d7\u671f\u9593\u304c\u77ed\u3044\u3053\u3068\uff0c\u8cbb\u7528\u306b\u3064\u3044\u3066\u691c\u8a0e\u3057\u3066\u3044\u306a\u3044\u3053\u3068\uff0c\u306a\u3069\u304c\u6319\u3052\u3089\u308c\u308b\uff0e<\/p>\n

\u7d50\u8ad6\u3000\u65e9\u671f\u30ea\u30ba\u30e0\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u306f\uff0c\u65e9\u671f\u5fc3\u623f\u7d30\u52d5\u3068\u5fc3\u8840\u7ba1\u75be\u60a3\u3092\u6709\u3059\u308b\u60a3\u8005\u306b\u304a\u3044\u3066\uff0c\u901a\u5e38\u306e\u30b1\u30a2\u306b\u6bd4\u3079\u3066\u6709\u5bb3\u306a\u5fc3\u8840\u7ba1\u8ee2\u5e30\u306e\u30ea\u30b9\u30af\u304c\u4f4e\u3044\u3053\u3068\u3068\u95a2\u9023\u3057\u3066\u3044\u305f\uff0e<\/p>\n

\"\"<\/p>\n

\"\"<\/p>\n

\"\"<\/p>\n

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