Jędrzejczyk-Patej Ewa, Lenarczyk Radosław, Pruszkowska Patrycja, Kowalski Oskar, Mazurek Michał, Sokal Adam, Boidol Joanna, Woźniak Aleksandra, Pluta Sławomir, Szulik Mariola, Liberska Agnieszka, Kalarus Zbigniew
Department of Cardiology, Congenital Hear t Disease and Electrotherapy, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland.
Cardiol J. 2014;21(3):309-15. doi: 10.5603/CJ.a2013.0110. Epub 2013 Aug 30.
The aim of the study was to assess the impact of atrial fibrillation (AF) with and without the need for atrioventricular junction (AVJ) ablation on outcomes in patients undergoing cardiac resynchronization therapy (CRT).
A single center cohort of 200 consecutive CRT patients was divided into three groups: 1) AF with CRT pacing < 95% in which AVJ ablation was performed (AF-ABL, n = 40; 20%), 2) AF without the need for AVJ ablation (AF-non ABL, n = 40; 20%), 3) sinus rhythm (SR, n = 120; 60%). All patients were assessed before CRT implantation and at 6-month follow-up. Positive clinical response to CRT was considered alive status without the need for heart transplantation and improvement ≥ 1 NYHA after 6 months. The comparative analysis among all study groups with respect to response-rate and long-term survival was performed.
The 6-month response-rate in both AF-ABL and AF-nonABL was significantly lower than in SR (52.5 and 50 vs.77.5%, respectively; both p < 0.017), though there were no differences in baseline characteristics among study groups apart from higher baseline NT-proBNP levels in AF-ABL. However, after adjustment for this confounder, and despite optimal CRT pacing burden in study groups, the remote all-cause mortality during median follow-up of 36.1 months was significantly higher in AF-ABL than in SR (adjusted HR = 2.57, 95% CI 1.09-6.02, p = 0.03). What is more, no difference in long-term survival between SR and AF-nonABL was observed.
Despite the improvement of CRT pacing burden and thus response-rate up to the level of AF subjects without the need for ablation, the long-term survival of AF patients requiring AVJ ablation remains still worse than in SR.
本研究的目的是评估伴有或不伴有房室结（AVJ）消融的心房颤动（AF）对接受心脏再同步治疗（CRT）患者预后的影响。
将连续200例CRT患者的单中心队列分为三组：1）CRT起搏<95%的房颤且进行了AVJ消融（AF-ABL，n = 40；20%），2）无需AVJ消融的房颤（AF-非ABL，n = 40；20%），3）窦性心律（SR，n = 120；60%）。所有患者在CRT植入前和随访6个月时进行评估。对CRT的阳性临床反应被认为是存活状态，无需心脏移植，且6个月后纽约心脏协会（NYHA）心功能分级改善≥1级。对所有研究组的反应率和长期生存率进行了比较分析。
AF-ABL组和AF-非ABL组的6个月反应率均显著低于SR组（分别为52.5%和50%对77.5%；p均<0.017），尽管除AF-ABL组基线NT-proBNP水平较高外，各研究组的基线特征无差异。然而，在对该混杂因素进行校正后，尽管各研究组的CRT起搏负担达到最佳，但在中位随访36.1个月期间，AF-ABL组的全因远期死亡率显著高于SR组（校正后风险比[HR]=2.57，95%置信区间[CI]1.09 - 6.02，p = 0.03）。此外，未观察到SR组和AF-非ABL组在长期生存率上的差异。
尽管CRT起搏负担有所改善，反应率提高到了无需消融的房颤患者的水平，但需要AVJ消融的房颤患者的长期生存率仍低于SR组患者。
