University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9047, USA
University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9047, USA Veterans Health Administration (VA) North Texas Healthcare System, 450 South Lancaster Road, Dallas, TX 75216, USA.
Europace. 2014 Jun;16(6):880-6. doi: 10.1093/europace/eut392. Epub 2014 Feb 12.
Atrioventricular junction ablation (AVJA) combined with biventricular (BiV) pacing (AVJA/BiV) is an effective treatment for refractory atrial fibrillation (AF) and rapid ventricular response (RVR) associated with heart failure (HF). This study compared the outcomes between patients with non-ischaemic (DCM) and ischaemic cardiomyopathy (ICM) following AVJA/BiV for AF/RVR.
This was a retrospective study of 45 patients, comparing the response to AVJA/BiV in patients with ICM to those with DCM. The study compared (a) the change in echocardiographic parameters of HF (ejection fraction (EF) and left ventricular dimensions) prior to, and at least 6 months post AVJA/BiV; and (b) HF hospitalizations (HFH) and appropriate implantable cardioverter defibrillator (ICD) therapies occurring post-procedure. Ejection fraction improved significantly in the DCM group (ΔEF 11.2% ± 11.9; P< 0.01); however, EF remained unchanged (ΔEF 0.5% ± 9.9; P = NS) in the ICM group post-AVJA/BiV. Post-procedurely, HFH were significantly more common (15/18 vs. 4/25; P < 0.0001), and there were significantly more appropriate ICD therapies (9.4 ± 12.3 vs. 2.3 ± 6.1; P = 0.01) in the ICM compared with the DCM group.
After AVJA/BiV, there was significantly less post-procedural echocardiographic reverse remodelling, and more HFH in the ICM compared with the DCM group. In addition, significantly more appropriate ICD therapies occurred in ICM patients post-procedure. These differences may be due to the presence of more extensive discrete myocardial scar in patients with ICM. Furthermore, it is possible that tachycardia-induced cardiomyopathy plays more of a causative role in HF in patients with AF and DCM than those with ICM.
房室结消融（AVJA）联合双心室（BiV）起搏（AVJA/BiV）是治疗心力衰竭（HF）相关难治性心房颤动（AF）和快速心室反应（RVR）的有效方法。本研究比较了 AVJA/BiV 治疗 AF/RVR 后非缺血性（DCM）和缺血性心肌病（ICM）患者的结局。
这是一项回顾性研究，比较了 45 例 ICM 患者和 DCM 患者对 AVJA/BiV 的反应。研究比较了（a）AVJA/BiV 前后及至少 6 个月的 HF 超声心动图参数（射血分数（EF）和左心室内径）的变化；以及（b）术后发生的 HF 住院（HFH）和适当的植入式心脏复律除颤器（ICD）治疗。DCM 组 EF 显著改善（ΔEF 11.2%±11.9；P<0.01）；然而，AVJA/BiV 后 ICM 组 EF 无变化（ΔEF 0.5%±9.9；P=NS）。术后，HFH 更为常见（15/18 比 4/25；P<0.0001），ICM 组的适当 ICD 治疗更为常见（9.4±12.3 比 2.3±6.1；P=0.01）。
AVJA/BiV 后，与 DCM 组相比，ICM 组术后超声心动图反向重构明显减少，HFH 更多。此外，ICM 患者术后发生适当的 ICD 治疗明显更多。这些差异可能是由于 ICM 患者存在更广泛的离散心肌瘢痕。此外，在 AF 和 DCM 患者中，心动过速性心肌病可能比 ICM 患者中更可能是 HF 的致病因素。
