Bunch T Jared, May Heidi T, Bair Tami L, Jacobs Victoria, Crandall Brian G, Cutler Michael, Weiss J Peter, Mallender Charles, Osborn Jeffrey S, Anderson Jeffrey L, Day John D
Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah, USA.
J Cardiovasc Electrophysiol. 2015 Apr;26(4):363-370. doi: 10.1111/jce.12602. Epub 2015 Feb 11.
Catheter ablation of atrial fibrillation (AF) is an established therapy for symptomatic patients. The long-term efficacy and impact of catheter ablation among patients with severe systolic heart failure (SHF) requires additional study to understand if outcomes achieved at 1 year are maintained and mechanisms of AF recurrence.
Three groups with SHF and 5 years of follow-up were matched 1:4:4 by age (±5 years) and sex: AF ablation patients receiving their first ablation (n = 267), AF patients that did not receive an ablation (n = 1,068), and SHF patient without AF (n = 1,068). SHF was based upon clinical diagnosis and an ejection fraction (EF) ≤35%. Patients were followed for 5-year primary outcomes of AF recurrence, heart failure, stroke, death, and cardiac function.
At 5 years, 60.7% of patients had clinical recurrence of AF. Diabetes and a prior heart attack were significant predictors of long-term risk of AF recurrence. Long-term mortality rates were 27%, 55%, 50%, in the AF ablation, AF, and no AF groups, respectively (P < 0.0001), with the lower rates attributed to lower cardiovascular mortality. At 5 years, there was no difference in EF, yet HF hospitalizations were lower following AF ablation compared to patients with AF and no ablation. Stroke rates at 5 years trended to be lower in the AF ablation group, but the difference was not statistically significant.
Recurrence rates of AF in patients with SHF after ablation are common at 5 years with an anticipated ongoing increase. Long-term AF-related comorbidities tended to be less in the AF ablation group.
导管消融治疗心房颤动（AF）是一种针对有症状患者的既定疗法。对于严重收缩性心力衰竭（SHF）患者，导管消融的长期疗效和影响需要进一步研究，以了解1年时取得的疗效是否能维持以及房颤复发的机制。
将三组患有SHF且随访5年的患者按年龄（±5岁）和性别以1:4:4进行匹配：接受首次消融的房颤消融患者（n = 267）、未接受消融的房颤患者（n = 1,068）以及无房颤的SHF患者（n = 1,068）。SHF基于临床诊断且射血分数（EF）≤35%。对患者进行5年的随访，观察房颤复发、心力衰竭、中风、死亡和心功能等主要结局。
5年时，60.7%的患者出现房颤临床复发。糖尿病和既往心脏病发作是房颤复发长期风险的重要预测因素。房颤消融组、房颤组和无房颤组的长期死亡率分别为27%、55%、50%（P < 0.0001），较低的死亡率归因于较低的心血管死亡率。5年时，射血分数无差异，但与房颤患者和未消融患者相比，房颤消融后心力衰竭住院率较低。房颤消融组5年时的中风发生率有降低趋势，但差异无统计学意义。
SHF患者消融后房颤复发率在5年时很常见，且预计会持续增加。房颤消融组与房颤相关的长期合并症往往较少。
