Nademanee Koonlawee, Amnueypol Montawatt, Lee Frances, Drew Carla M, Suwannasri Wanwimol, Schwab Mark C, Veerakul Gumpanart
Pacific Rim Electrophysiology Research Institute at White Memorial Hospital, Los Angeles, California, and Bangkok, Thailand.
Pacific Rim Electrophysiology Research Institute at White Memorial Hospital, Los Angeles, California, and Bangkok, Thailand.
Heart Rhythm. 2015 Jan;12(1):44-51. doi: 10.1016/j.hrthm.2014.09.049. Epub 2014 Oct 11.
The benefits of catheter ablation for elderly patients with atrial fibrillation (AF) with respect to mortality and stroke reductions remain unclear.
The purpose of this study was to evaluate the safety and efficacy, including long-term outcomes, of catheter ablation for maintaining normal sinus rhythm (NSR) in elderly patients with AF.
We evaluated 587 elderly patients (age ≥75 years) with AF. Of the 324 who were eligible for ablation, 261 (group 1) underwent ablation guided by complex fractionated atrial electrogram. The remaining 63 patients (group 2) either declined or were not suitable for ablation. The end-points were NSR, stroke, death, and major bleeding.
Two hundred sixteen patients (83%) remained in NSR compared to only 14 group 2 patients (22%; mean follow-up 3 ± 2.5 years, P <.001). The 1- and 5-year survival rates for group 1 with NSR, group 1 with AF, and group 2 patients were 98% and 87%, 86% and 52%, and 97% and 42%, respectively (P <.0001). NSR was an independent favorable parameter for survival (hazard ratio [HR] 0.36; 95% CI, 0.02-0.63, p = 0.0005), whereas older age (HR 1.09, 95% CI 1.01-1.16, P = .02) and depressed ejection fraction <40% (HR 2.38, 95% CI 1.28-4.4, P = .006) were unfavorable. Warfarin therapy was discontinued in 169 of the 216 group 1 patients (78%) who maintained NSR and had only 3% 5-year stroke/bleeding rates compared to 16% in group 2 (P <.001).
Elderly patients with AF benefit from AF ablation, which is safe and effective in maintaining sinus rhythm and is associated with lower mortality and stroke risks.
导管消融术对老年房颤（AF）患者在降低死亡率和中风方面的益处仍不明确。
本研究旨在评估导管消融术在老年房颤患者中维持正常窦性心律（NSR）的安全性和有效性，包括长期预后。
我们评估了587例年龄≥75岁的老年房颤患者。在324例符合消融条件的患者中，261例（第1组）接受了基于房颤碎裂电位指导的消融。其余63例患者（第2组）拒绝或不适合消融。终点指标为NSR、中风、死亡和大出血。
216例患者（83%）维持NSR，而第2组仅有14例患者（22%）维持NSR（平均随访3±2.5年，P<.001）。第1组维持NSR患者、第1组房颤患者和第2组患者的1年和5年生存率分别为98%和87%、86%和52%、97%和42%（P<.0001）。NSR是生存的独立有利参数（风险比[HR]0.36；95%CI，0.02 - 0.63，p = 0.0005），而年龄较大（HR 1.09，95%CI 1.01 - 1.16，P =.02）和射血分数<40%（HR 2.38，95%CI 1.28 - 4.4，P =.006）则不利。在第1组216例维持NSR的患者中，169例（78%）停用了华法林，其5年中风/出血率仅为3%，而第2组为16%（P<.001）。
老年房颤患者可从房颤消融术中获益，该手术在维持窦性心律方面安全有效，且与较低的死亡率和中风风险相关。
