Geng Jin, Zhang Yanchun, Wang Yanhan, Cao Lijuan, Song Jie, Wang Bingjian, Song Wei, Li Ju, Xu Wei
Department of Cardiology, Huai'an First People's Hospital, Nanjing Medical University Department of Cardiology, Huai'an Second People's Hospital, the Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, Jiangsu Department of Cardiology, Nanjing Jiangning Hospital Department of Cardiology, Nanjing Drum Tower Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
Medicine (Baltimore). 2017 Dec;96(49):e9179. doi: 10.1097/MD.0000000000009179.
Many trials have shown improvements in left ventricular function, exercise capacity, and quality of life after catheter ablation (CA) of atrial fibrillation (AF) in patients with heart failure (HF). We sought to evaluate the impact of CA on hard outcomes in a retrospective cohort study. AF patients with symptomatic HF from 3 hospitals were included. Our primary endpoint was major adverse cardiac events (MACEs), a composite of all-cause mortality, stroke, and unplanned hospitalization. In total, 90 patients underwent CA and 304 ones received rate control (RaC) were included. After a mean follow-up of 13.5 ± 5.3 months, 82.2% of patients in CA group got freedom from AF; all patients in RaC group remained in AF. CA group had a significant decreased risk of MACEs compared with RaC group (13.3% vs 29.3%, hazard ratio [HR] 0.51, 95% confidence interval [CI]: 0.32-0.82, P = .005). After propensity score matched for confounding factors, difference in MACEs remained significant between groups (13.3% vs 25.6%, HR 0.50, 95% CI: 0.26-0.98, P = .044). Multivariate regression analysis also indicated that CA was significantly associated with a lower risk of MACEs in overall cohort (HR 0.486, 95% CI: 0.253-0.933, P = .030) and in propensity-matched cohort (HR 0.482, 95% CI: 0.235-0.985, P = .045). Besides, age and NYHA class were associated with an increased risk of MACEs. In conclusion, the present study demonstrated that CA for AF in HF patients could reduce the risk of MACEs in a mid-term follow-up. Thus, CA may be a reasonable option for this population.
许多试验表明，心力衰竭（HF）患者进行心房颤动（AF）导管消融（CA）后，左心室功能、运动能力和生活质量均有所改善。我们试图在一项回顾性队列研究中评估CA对严重结局的影响。纳入了来自3家医院的有症状HF的AF患者。我们的主要终点是主要不良心脏事件（MACE），即全因死亡率、中风和非计划住院的综合指标。总共纳入了90例行CA的患者和304例接受心率控制（RaC）的患者。平均随访13.5±5.3个月后，CA组82.2%的患者房颤消失；RaC组所有患者仍处于房颤状态。与RaC组相比，CA组MACE风险显著降低（13.3%对29.3%，风险比[HR]0.51，95%置信区间[CI]：0.32-0.82，P = 0.005）。在对混杂因素进行倾向评分匹配后，两组间MACE差异仍显著（13.3%对25.6%，HR 0.50，95%CI：0.26-0.98，P = 0.044）。多变量回归分析还表明，在整个队列（HR 0.486，95%CI：0.253-0.933，P = 0.030）和倾向匹配队列（HR 0.482，95%CI：0.235-0.985，P = 0.045）中，CA与较低的MACE风险显著相关。此外，年龄和纽约心脏病协会（NYHA）分级与MACE风险增加相关。总之，本研究表明，HF患者AF的CA可在中期随访中降低MACE风险。因此，CA可能是该人群的合理选择。
