Grubitzsch Herko, Dushe Simon, Beholz Sven, Dohmen Pascal M, Konertz Wolfgang
Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany.
J Card Fail. 2007 Sep;13(7):509-16. doi: 10.1016/j.cardfail.2007.04.011.
Congestive heart failure (CHF) and atrial fibrillation (AF), both of which cause morbidity and mortality, are mutually promoting diseases. We aimed to evaluate surgical AF ablation in CHF.
Among 212 patients (age 69 +/- 8.8 years, 87% with persistent AF) undergoing concomitant left atrial (LA) ablation, 79 (37.3%) presented CHF (n = 62 with a left ventricular ejection fraction [LVEF] 0.31-0.45, n = 17 with an LVEF < or = 0.30). Patients with CHF were similar to controls regarding AF duration (61 +/- 65.1 months vs. 54 +/- 67.2 months, not significant [NS]), LA diameter (49 +/- 7.5 mm vs. 50 +/- 9.2 mm, NS), and heart rate (78 +/- 18.4 min(-1) vs. 81 +/- 21.3 min(-1), NS), but they required more circulatory support (17.7% vs. 1.5%, P < .001) and a longer intensive care unit stay (6 +/- 9.5 days vs. 4 +/- 10.5 days, P = .032). At follow-up after 13 +/- 7.3 months, 42 patients (66%) with CHF and 81 controls (74%, NS) were in sinus rhythm (SR) (55% and 64% without antiarrhythmic drugs, respectively, NS). Univariate and logistic regression analysis revealed that AF duration and LA diameter predicted rhythm outcome but not CHF. In patients with an LVEF of 0.30 or less, SR conversion significantly improved LVEF, New York Heart Association class, and Minnesota Living with Heart Failure score. Kaplan-Meier estimates suggested superior survival of patients with stable SR (100% vs. 73%, log-rank P < .05).
If patients presenting with CHF and AF require cardiac surgery, concomitant AF ablation should be considered, especially if left ventricular function is severely impaired.
充血性心力衰竭（CHF）和心房颤动（AF）均会导致发病和死亡，是相互促进的疾病。我们旨在评估CHF患者的外科房颤消融治疗。
在212例（年龄69±8.8岁，87%为持续性房颤）同时进行左心房（LA）消融的患者中，79例（37.3%）存在CHF（62例左心室射血分数[LVEF]为0.31 - 0.45，17例LVEF≤0.30）。CHF患者与对照组在房颤持续时间（61±65.1个月对54±67.2个月，无显著差异[NS]）、LA直径（49±7.5mm对50±9.2mm，NS）和心率（78±18.4次/分钟对81±21.3次/分钟，NS）方面相似，但他们需要更多的循环支持（17.7%对1.5%，P <.001）且重症监护病房停留时间更长（6±9.5天对4±10.5天，P = 0.032）。在13±7.3个月的随访中，42例（66%）CHF患者和81例对照组患者（74%，NS）处于窦性心律（SR）（分别有55%和64%未使用抗心律失常药物，NS）。单因素和逻辑回归分析显示，房颤持续时间和LA直径可预测心律结果，但CHF不能。在LVEF为0.30或更低的患者中，转为SR显著改善了LVEF、纽约心脏协会分级和明尼苏达心力衰竭生活评分。Kaplan - Meier估计表明，稳定SR患者的生存率更高（100%对73%，对数秩检验P <.05）。
如果患有CHF和AF的患者需要进行心脏手术，应考虑同时进行房颤消融，尤其是在左心室功能严重受损的情况下。
