Delnoy Peter Paul H M, Ottervanger Jan Paul, Luttikhuis Henk Oude, Elvan Arif, Misier Anand R Ramdat, Beukema Willem P, van Hemel Norbert M
Isala klinieken, Zwolle, The Netherlands.
Am J Cardiol. 2007 May 1;99(9):1252-7. doi: 10.1016/j.amjcard.2006.12.040. Epub 2007 Mar 13.
The prevalence of atrial fibrillation (AF) in patients with heart failure is high, but data about the effects of cardiac resynchronization therapy (CRT) in patients with chronic AF are scarce. In this prospective observational study of 263 consecutive patients, CRT was performed in 96 patients (37%) with chronic AF and 167 patients (63%) with sinus rhythm (SR). Echocardiographic and clinical parameters were evaluated at baseline and 3 and 12 months. Reverse left ventricular (LV) remodeling is defined as LV end-systolic volume decrease > or =10%. Hospitalization rates for heart failure in the year before and after implantation were compared. Baseline characteristics between patients with and without AF were similar, but the AF group had smaller LV end-systolic and end-diastolic volumes and larger left atrial dimensions. New York Heart Association class, 6-minute walking distance, quality-of-life score, LV ejection fraction, and mitral regurgitation improved significantly at 3 and 12 months in both groups, and the changes were similar. Reverse LV remodeling after 3 and 12 months was 74% and 82% (AF group) versus 77% and 83%, respectively (SR group, p = 0.79). After 1 year, cardioversion had occurred in 25% of patients with AF. In the year after implantation, significant decreases in hospitalizations for heart failure in both groups (84% and 90%) were documented. Long-term mortality was almost equal in both groups. In conclusion, this large-scale study shows that the benefit of CRT in patients with chronic AF and heart failure is similar to that in patients with SR. Patients with chronic AF and heart failure should be considered candidates for CRT.
心力衰竭患者中房颤（AF）的患病率很高，但关于心脏再同步治疗（CRT）对慢性房颤患者影响的数据却很稀少。在这项对263例连续患者的前瞻性观察研究中，96例（37%）慢性房颤患者和167例（63%）窦性心律（SR）患者接受了CRT治疗。在基线、3个月和12个月时评估了超声心动图和临床参数。左心室（LV）逆向重构定义为左心室收缩末期容积减少≥10%。比较了植入前后一年内心力衰竭的住院率。有房颤和无房颤患者的基线特征相似，但房颤组的左心室收缩末期和舒张末期容积较小，左心房尺寸较大。两组在3个月和12个月时，纽约心脏协会分级、6分钟步行距离、生活质量评分、左心室射血分数和二尖瓣反流均有显著改善，且变化相似。3个月和12个月后，房颤组的左心室逆向重构率分别为74%和82%，而窦性心律组分别为77%和83%（p = 0.79）。1年后，25%的房颤患者发生了心律转复。植入后一年，两组心力衰竭住院率均显著下降（分别为84%和90%）。两组的长期死亡率几乎相等。总之，这项大规模研究表明，CRT对慢性房颤合并心力衰竭患者的益处与对窦性心律患者相似。慢性房颤合并心力衰竭患者应被视为CRT的候选者。
