Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT, USA.
Department of Internal Medicine, Stanford University, Palo Alto, CA, USA.
J Cardiovasc Electrophysiol. 2018 Feb;29(2):221-226. doi: 10.1111/jce.13390. Epub 2017 Dec 13.
Catheter ablation of atrial fibrillation (AF) is an established therapeutic rhythm approach. Patients with a prior history of a stroke (CVA) represent a unique high-risk population for recurrent thromboembolic events. The role of antiarrhythmic treatment on the natural history of stroke recurrence in these patients is not fully understood.
Three patient groups with a prior CVA and 5 years of follow-up were matched 1:3:3 by propensity score (±0.01): AF ablation patients receiving their first ablation (n = 139), AF patients that did not receive an ablation (n = 416), and CVA patients without clinical AF (n = 416). Prior CVA was determined by medical chart review. Patients were followed for outcomes of recurrent CVA, heart failure, and death.
The average age of the population was 69 ± 11 years and 51% male. AF ablation patients had higher rates of hypertension and heart failure (P < 0.0001), but diabetes prevalence was similar between the groups (P = 0.5). Note that 5-year risk of CVA (HR = 2.26, P < 0.0001) and death (HR = 2.43, P < 0.0001) were higher in the AF, no ablation group compared those that were ablated. When comparing AF, ablation to no AF patients, there was not a significant difference in 5-year risk of for CVA (HR = 0.82, P = 0.39) and death (HR = 0.92, P = 0.70); however, heart failure risk was increased (HR = 3.08, P = 0.001).
In patients with AF and a prior CVA, patients undergoing ablation have lower rates of recurrent stroke compared to AF patients not ablated. Although the full mechanisms of benefit are unknown, as CVA rates are similar to patients without AF these data are suggestive of a potential altering of the natural history of disease progression.
房颤（AF）的导管消融是一种已确立的治疗节律方法。有中风（CVA）病史的患者是复发性血栓栓塞事件的独特高危人群。抗心律失常治疗在这些患者中风复发的自然史中的作用尚不完全清楚。
通过倾向评分（±0.01）对有中风病史和 5 年随访的 3 组患者进行 1:3:3 匹配：接受首次消融的 AF 消融患者（n=139）、未接受消融的 AF 患者（n=416）和无临床 AF 的 CVA 患者（n=416）。中风病史通过病历回顾确定。患者随访中风复发、心力衰竭和死亡的结局。
人群的平均年龄为 69±11 岁，51%为男性。AF 消融患者高血压和心力衰竭的发生率较高（P<0.0001），但各组之间的糖尿病患病率相似（P=0.5）。请注意，与接受消融的患者相比，AF 无消融组的 5 年中风（HR=2.26，P<0.0001）和死亡（HR=2.43，P<0.0001）风险更高。与无 AF 患者相比，比较 AF 消融与无 AF 患者，5 年中风（HR=0.82，P=0.39）和死亡（HR=0.92，P=0.70）风险无显著差异；然而，心力衰竭风险增加（HR=3.08，P=0.001）。
在有 AF 和中风病史的患者中，与未消融的 AF 患者相比，接受消融的患者中风复发率较低。尽管获益的全部机制尚不清楚，但由于中风发生率与无 AF 患者相似，这些数据提示疾病进展的自然史可能发生改变。
